Saturday, April 07, 2018

Implantation dysfunction

When patients fail repeated IVF cycles, the "diagnosis" their doctor offers them is - Implantation Dysfunction .
However, this is really just a waste paper basket diagnosis - it does not provide any useful actionable information . It's a mouthful, but it's just a description of the fact that their embryos have consistently failed to implant for an unknown reason.
Making a diagnosis - and receiving one - often gives both patients and doctors a lot of comfort, because they feel that once they have been able to put a name to the problem, they will be able to tackle it better. Sadly, this is often just a delusion !

Thursday, April 05, 2018

Laparoscopy and IVF - before, after or never ?

Before referring a patient for IVF to an IVF clinic, many gynecologists will insist on doing a laparoscopy . They justify this using all kinds of pretexts. saying" We will get a chance to check your pelvis, so we can clip your tubes, if needed, or burn any endometriosis." Their justification is that doing this will improve the patient's chance of getting pregnant with IVF. This is false, but poor patients don't know any better. They feel that if they are going to spend so much money on IVF, they might as well spend a little bit more on the laparoscopy, if this will improve their IVF success rate !

Removing small fibroids and cysts is pointless, and does not affect IVF treatment, which is why they are best left alone !

In fact, a lot of IVF doctors will also refer their patients back to their gynecologists for a laparoscopy , because they follow a "You scratch my back and I'll scratch yours" model - " If you send patients to me for IVF , then I will send them back to you for a laparoscopy so that both of us are happy." Of course, the poor patient is the only one who is a loser in this entire business. This is why it's important that patients need to learn to speak up and ask, " How is the laparoscopy going to change anything?"

Obviously , if it doesn't, then please say No ! There's no such thing as a minor procedure or minimally invasive surgery - any surgical procedure carries risks. In fact, a laparoscopy can reduce your chances of getting pregnant with IVF, because overenthusiastic surgeons can reduce your ovarian reserve while cauterizing endometriosis ! 

Lots of gynecologists also want to do laparoscopies for patients who have failed an IVF cycle, saying, " If we do a laparoscopy we'll be able to figure out what the reason for the failure is."  Again, this is just not true, but unfortunately patients aren't assertive, and they're not well informed enough to be able to ask intelligent questions. Sometimes they agree, simply because they are so desperate because their IVF cycle has failed. They agree with anything their doctor says, without realizing that it's not going to help them - it just causes them to waste their money.

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Monday, March 26, 2018

The 7 steps of IVF

IVF seems to be an extremely complicated procedure, and sometimes IVF doctors take perverse pleasure in mystifying it, because they like showing off their expertise. This is why IVF  patients are often completely confused about what to expect. Actually , it's very straightforward and logical, and if you understand this simple framework , you will be able to make sure your doctor's doing the right stuff for you.
Remember that all we are doing in an IVF cycle is replicating what should have happened normally in the fallopian tubes - the only difference is that we are doing this in the test tube !
1. First is the pre-IVF testing, or the workup. These are simple tests, to make sure whether IVF is the right treatment for you; and what kind of IVF you require ( for example, if this should be IVF or ICSI).
(a). semen analysis for your husband ( to check his sperm count and motility);             
(b)  blood tests for you for the following reproductive hormones - FSH ( follicle-stimulating hormone),LH ( luteinising hormone),PRL ( prolactin) , AMH ( anti-Mullerian hormone) and TSH ( thyroid stimulating hormone) on Day 3 of your cycle, ( to check the quality of your eggs). 
(c)  A vaginal ultrasound scan on Day 10 or 11 which should check for a. ovarian volume; b. antral follicle count; c. uterus morphology; d. endometrial thickness and texture, to confirm your uterus is normal. 
If there is a problem, then this can be treated prior to starting IVF!
2. Second is the stage of superovulation , where the doctor gives you hormonal injections in order to help you to grow lots of eggs. The growth of the follicles is monitored using vaginal ultra sound scans and blood estradiol levels.
3. The third step is that of egg collection ( egg retrieval) , where he collects the eggs from your mature follicles, and sends them to the embryologist in the IVF lab, where they are placed in culture medium. 
4. Then comes fertilization, where either using IVF or ICSI, the embryologist adds sperm to the egg. 
5. Then is the process of embryo culture, where the embryos are grown in the IVF laboratory in the incubator, so they divide and grow , till they form blastocysts. 
6. This is followed by embryo transfer, where the embryos are put back in the uterus with the hope that they will implant. 
7. The final step is that of cryopreservation (freezing for storage) where the extra embryos can be frozen in liquid nitrogen , so that they can be used for future attempts. This ensures nothing is wasted or thrown away.
Once you understand this framework, you will know exactly what your doctor is doing - and why ! Please make sure that your doctor follows all these steps , so that you know that you're getting the best possible medical care. You can't afford to leave everything up to a doctor, especially in this day and age , where there are so many new IVF clinics cropping up all the time . They are run by inexperienced doctors , and managed by their assistants, most of whom don't have a clue as to what is happening !
As an enlightened patient, you need to take charge !
Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Saturday, March 24, 2018

Why measuring uterine blood flow is pointless in an IVF cycle

Lots of IVF specialists monitor uterine blood flow during an IVF cycle. They believe that this helps them to track uterine receptivity, and good flow correlates with implantation rates. This makes logical sense, which is why so many sonographers study uterine blood flow doppler wave forms and the PI ( pulsatility index)

I think this is meaningless.

The fact that the endometrium is growing to a thickness of 8 mm means that it is receiving adequate perfusion - how would it be able to grow without an adequate blood supply ?

This is another one of those measurements which are of no clinical value - but are done simply because we have the technology to do it !

Tuesday, March 20, 2018

Using the embryoscope to take IVF patients for a ride

Many IVF clinics claim to use an embryoscope to culture embryos in vitro. While this provides great video images of the developing embryos, it has not been proven to improve IVF pregnancy rates. However, patients are quite happy to pay extra for this, because the doctor claims this is the "latest advance", and that's fine.

However, the tragedy is that these doctors actually are just fooling the poor patient, and they never use the embryoscope at all for them - they just claim to !

This is because they refuse to give patients the video generated by the embryoscope ! The absence of the video is proof that the embryoscope was never used !

The tragedy is that patients are still poorly informed, which means it's surprisingly easy to take them for a ride in order to make a quick buck. It's clinics like this which give all IVF clinics a bad reputation !

Monday, March 19, 2018

Mindless IVF overtesting

When an IVF cycle fails because of poor quality embryos, rather than acknowledge the fact that often the result for the poor quality embryos is a poor quality IVF lab, IVF doctors are happy to blame "abnormal genetics" as the cause for the embryo fragmentation.

They then send the poor patient off on a wild goose chase, by ordering expensive tests such as karytotype    ( chromosomal studies) , sperm FISH, and sperm DNA fragmentation, even though these are completely pointless and useless.

The truth is that most IVF doctors understand very little about the limitations of genetic tests, and are happy to pass the buck and clutch at straws by referring the patient to a "geneticist" !

Even worse , some will flat out tell the patient that their poor quality embryos are proof that the sperm or egg are genetically defective, and they need to use donor egg/ donor sperm/ donor embryo !

Tuesday, March 13, 2018

What can we do differently in the next IVF cycle ?

When an IVF cycle fails, this is the commonest question which patients ask - What can we do differently next  time ?
They naively believe that the fact that the cycle failed means something went "wrong", and if we identify and  " correct" this, the next cycle will succeed.

This is why doctors do lots of tests; and propose lots of new and more "advanced" treatments, in order to improve the chances of a pregnancy.

Here's a list of the tests which may be proposed , to allow the doctor to "investigate" the reason for the failed implantation in more details


The list of "treatments" to fix these problems is equally long

Immune therapy

The problem is this is flawed thinking, based on unrealistic expectations . An embryo is not a baby, and we don't have the tools to be able to drill down and find out why an embryo did not implant.

Yes, we can provide generic reasons such as "poor endometrial receptivity", but these are "waste-paper basket " diagnoses. We can never prove disprove these labels, which is why they don't provide any useful actionable information.

If the doctor transferred top quality blastocysts into a 8 mm trilaminar endometrium, then all you need to do is to be patient and repeat the cycle until you get pregnant. Changing something just for the sake of doing something different is not a good idea.

The problem is that doctors are also prejudiced to doing something "new and different" - partly because they like playing with the newest toys, and partly because they can charge more for doing these .

Also, because some patients will get pregnant after these tests and treatments , both doctors and patients get fooled into thinking that it was the new treatment which resulted in the success. This is the classical "post hoc, ergo propter hoc" fallacy which seduces so many people. The reality is that lots of these patients would have got pregnant even if the doctor had done nothing new !

The rule is simple - caveat emptor ! Don't let the doctor use you like a guinea pig !

Is my IVF doctor taking me for a ride ?

A patient sent me this email.
I am going through an IVF cycle . Egg retrieval has already been done and as per the doctor's report , 10 embryos were formed.. Then we were told that instead of fresh ET , he will.go for frozen cycle , so that ovary comes to to.normalcy, and he started me on 21 days birth control pill. I am upset that he did not explain this to me before we started.
This month in this cycle (as today is day 13) my endometrium has reached only till 6.5 wherein last month it was 9mm. Is this normal?
If the transfer is not done in this cycle will there be a negative impact on my embryos due to prolonged freezing?
What should I do to increase my endometrium layer. Already having 2 x progynova tab  thrice a day..
Please i being fooled by this IVF business? there something wrong with me?

It breaks my heart when I see how poorly IVF patient are treated by doctors.

A good doctor will define a treatment plan before starting the cycle , and not change this at the last minute,without  explaining to the patient why he is doing so. A good patient will speak up and ask for answers. The trouble is that patients are very vulnerable , and are very scared of upsetting or offending their doctor by asking questions, which is why they are forced to keep quiet. They bottle their resentment, but this comes bubbling forth when the cycle fails, and the reputation of all IVF doctors takes a beating !

Monday, March 12, 2018

If you want to find a good IVF doctor, you need to be a good patient !

Many patients naively assume that all IVF doctors are equally good, while the reality is very different.

However, if's hard for a poorly informed patient to differentiate between a good doctor and a bad doctor - and bad doctors take advantage of a patient's ignorance !

A good doctor will always proactively provide complete documentation of the IVF treatment cycle, including embryo photos. Similarly, a good patient will always demand this as well, and not leave everything upto the doctor's discretion !

Aggressive and trigger happy IVF doctors !

It amazes me how aggressive IVF doctors have become.

I saw a patient today, who had bacteria in his semen culture( a completely pointless and useless test, which should not have been done in the first place.)

Because this did not clear up with antibiotics, the doctor referred him to a urologist, who advised him to do a TESA ( testicular sperm aspiration) in order to prevent any infection of the eggs !

This is uncalled for and ridiculous! When we prepare the sperm in the lab for doing IVF/ICSI, the bacteria are removed as well, so the culture results do not not affect the treatment outcome !

Friday, March 09, 2018

Freezing all your embryos in order to improve IVF success rates.

Patients have traditionally been reluctant to freeze their embryos because they're worried that freezing embryos will cause them to die. However, the reality is that the flash-freezing technology ( vitrification or ultra-rapid freezing) has become so good,  that survival rates are routinely 100% in good labs , when we freeze top-quality embryos.
When patients have lots of embryos, they're quite happy to freeze their spare embryos. They understand that we can't transfer all their embryos at one time, and they don't want to waste their extra embryos. However, the truth is that embryo freezing is even more valuable for women with very few embryos - even those who have only one.
When you have few embryos, each embryo is even more precious - it's literally worth its weight in gold ! Every top quality embryo has the potential to become a baby , but it will implant only if it is transferred into a receptive endometrium.
Now, the problem in  a fresh IVF cycle is that our focus is on helping you to grow lots of eggs, which is why we superovulate you with hormonal injections. While the endometrium looks fine because of the high estrogen levels this causes, its receptivity is often  compromised because of these supraphysiological hormone levels. After all, the primary goal was to grow eggs , not to prepare the endometrium. This means that even though the endometrium may look thick and trilaminar in a vaginal ultrasound scan, it may not be perfect for allowing implantation. This means that even if you put back a top quality embryo in this endometrium, it has a reduced chance of implanting.
This is why we suggest to all our patients that we freeze all their embryos - even if they have only 1-2. If these are top quality embryos, we can pretty much guarantee them that they will survive the thaw, so they aren't taking any risk. We can then transfer them in the next cycle , at which point our exclusive focus is on preparing the endometrium for optimal receptivity . This combination technique is the best method for ensuring that these precious embryos have the best chance of implanting and becoming a baby.
This " freeze-all" option is a standard treatment protocol offered all over the world, and we encourage our patients to opt for this. The downside is that it costs more ( because they have to pay for the freezing and thawing), and takes longer ( because they need to come back the next cycle for their transfer), but it's well worth it !
Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Thursday, March 08, 2018

Why are my babies dying at 8 weeks of pregnancy ?

A patient sent me this email

Doctor, I have had many miscarriages at 8 weeks of pregnancy. I have no problem getting pregnant, but the last 5 pregnancies have ended in a missed abortion. I am at my wit's end - what should I do ?
Recurrent miscarriages are a very frustrating problem for both doctors and patients ! Patients blame themselves for the death of their baby, and doctors are unable to provide an accurate diagnosis or a reliable solution.

We do know that the commonest reason for a miscarriage is a genetic abnormality in the fetus, and this is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because these eggs have more genetic abnormalities, because they have "aged" and have genetic defects, which we do not yet have the technology to be able to screen for.

While we do perform basic tests to rule out correctable anomalies, in most patients we are not able to pinpoint the underlying cause, which means we are often shooting in the dark, and the only treatment we can offer is empiric therapy !

You can read more about this at

Wednesday, March 07, 2018

What was the reason for the failed implantation ?

One of our patients sent me this email.

We were hoping for some detailed response from you which would have given us some comfort as this time we are very very shocked. We believed that the use of donor egg would resolve my egg quality issue but things doesn't seem to have changed.
I clearly remember in my first cycle, at the time of my ET, we had only one embryo left for transfer and which was at morula stage. You had explained the reason for low number of embryos and slow growth was due to the poor quality of my egg, which had failed to provide energy to the embryo to develop. Even when implantation had failed at that time, you had said the reason was poor quality of the egg. So, does this mean that in this cycle, the eggs which were used were also of poor quality which is why we received less number of good quality embryos and also failed implantation?
Another thing which we also recollect from our first cycle is that we were worried whether it was a sperm issue for failed implantation and whether we should we go for some tests like PGD. You had explained that egg quality is generally responsible for poor embryos and that poor sperm quality do not affect embryo quality after ICSI. Hence, the requirement of any tests was also ruled out.
My uterus and endometrium lining was also perfect during this cycle. So what could be the reason for failed implantation this time? This is a big question. We made the toughest decision of our lives to go with the donor eggs but still the question remains unanswered is something which is not acceptable and hence we look up to you for your fine judgement and expertise.
Now, after having failed implantation from the one and only top quality blasto, we don't know how those two remaining frozen embryos will help if its not from a good quality donor eggs because we don't want to build any hopes for something which is having very little chance of success. 

This was my answer.

These are good questions - but no one in the world can answer them, sorry, so you will have to accept the fact that  reproductive sciences have limits
There are certain things we can control - and lots we can't, and we need to learn to live with this uncertainty and unpredictability
Yes, we could lots of useless tests for you, but none of them would answer any of the questions you are asking
Please have realistic expectations of what medical science can do for you
I would suggest you might want to get a second opinion from another IVF doctor, so you can reassure yourself that we are providing you with good quality care
We do want to give you a baby, which is why we  reduced our fees for you - but we have no control over implantation, which is an in utero biological process
Yes, I would suggest you transfer your frozen embryos, but there is no certainty they will become babies. However, if you do not transfer them, it is 100% certain they will not become babies !

Please remember the Serenity Prayer
God grant me the serenity to accept the things I cannot change;
the courage to change the things I can;
and the wisdom to know the difference.
I did try to call you, and will be happy to answer any questions, but please understand that we don't always have answers - I wish we did !

Tuesday, March 06, 2018

Why don't IVF patients insist on embryo photos ?

All IVF patients know that the only tangible product an IVF clinic can deliver is embryos.  After the embryo has been transferred into the uterus, the doctor has no control over the implantation process. This is a complex biological phenomenon, and is impacted by many variables, most of which we do not understand.

This is why it's so important that IVF clinics provide embryo photos to all their patients - so they can prove they have provided high quality medical care, irrespective of the outcome of the IVF cycle ( which is not in anyone's control). This is good for both the doctor and the patient, and is a practise all good clinics follow all over the world.

In this day and age, when so many IVF patients from India spend hours on google in order to learn about IVF, it continues to amaze me why even these articulate, well-read, highly educated , assertive and affluential women don't insist on their IVF doctors giving them photos of their embryos prior to transfer ?

Is it because they are scared to speak up ? Because they are women ?

Would it help if their husbands took a more active role ?

Monday, March 05, 2018

What is a Grade A embryo ?

It breaks my heart when I see the poor quality of IVF treatment today most patients get today.

There is no transparency or openness, and no SOPs ( standard operating procedures). Everything seems to be done on an ad-hoc basis, depending upon the doctor's whims and fancies.

Thus, many doctors tell their patients they have transferred  Grade A embryos for them. The patient is very happy, because she is very impressed with how good the doctor is !

However, the doctor does not bother to provide any photos of the embryos, and it seems that the patient is forced to take the doctor's word for the quality of her embryos.

Good IVF clinics routinely and proactively provide embryo photos to all their patients ! Not only does this increase the patient's confidence level in the clinic, it also helps to document that they are providing high quality care - something which all good clinics are proud to do !

Sunday, March 04, 2018

Is normal pregnancy possible after failed IVF treatment?

A patient sent me this email - 

Is normal pregnancy possible after failed IVF treatment? 
Patients often go to pieces after their IVF cycle fails. This is partly because they have very unrealistic expectations of IVF technology; and partly because their IVF doctors mislead them.

When  IVF clinics want patients to sign up for an IVF cycle with them, they are in "sell-mode" , and make all kinds of unreasonable promises, to convince the patient to come to them for their IVF treatment.

For example, the doctor is very bubbly and cheerful at the time of the embryo transfer, and tells the patient that all their embryos are Grade A and their chances of success are 90% . Patients are obviously thrilled, even though the doctor is clearly lying -and has not even bothered to give them photos of their embryos !

To add insult to injury, when the cycle fails, the doctor blames the patient, saying that she didn't rest enough; or that her body "rejected" the embryo !

The truth is that the commonest cause for IVF failure in India today is poor quality IVF treatment !

Many patients can and do get pregnant after a failed IVF cycle, especially if they have unexplained infertility; or medical issues  such as PCOD, which can be treated with simpler alternatives !

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Tuesday, February 27, 2018

The commonest reason for IVF failure

The reason is often poor quality embryos - and this is often because of a poor quality IVF clinic.

The tragedy is that most patients are not unaware of the reason their IVF cycle failed, because doctors refuse to give them photos of their embryos !

This is a red flag - good clinics provide embryo photos routinely and proactively to all their patients, to document they have done the treatment properly, and to enhance trust !

Need help in analysing why your IVF cycle failed ?
Please send me your medical details by filling in the form at so that I can guide you !

The free IVF camp mela !

Many IVF clinics have started offering free IVF camps.

This seems like a great deal for infertile couples  - after all,who would say No to a free consultation from an IVF specialist ? What's the harm in getting an opinion ?

Instead of Mohammed going to the mountain, here the mountain is coming to Mohammed ! Isn't this something any sensible patient would take advantage of ?

The reality is that nothing in life comes free !

They use this as a ploy to attract infertile patients, so they can grow their sales funnel, and increase the number of IVF cycles they do every year. The problem is that this is a tactic used not to help patients, but to drum up business.

Every patient who walks into the camp is offered IVF  treatment, even if they don't need it, and could have got pregnant with much simpler and cheaper treatment. They are offered large discounts, to make the offer even more attractive ! The irony is that the IVF success rate for these patients is very high, because they did not need IVF in the first place ! However, when they get pregnant, the sing the praises of the IVF clinic to everyone they meed, thus setting up a great word of mouth marketing cycle for the clinic !

This is why these camps have become so popular - they offer a great ROI for the clinic !

Sunday, February 25, 2018

Why are you more expensive than other IVF clinics ?

A patient sent me this email

Why are you more expensive than other IVF clinics ?
This is a perfectly reasonable question, because IVF treatment is expensive, and patients need to keep an eye on their expenses. Because they naively believe that all IVF clinics are created equal, they often prefer going to the cheapest one - or the one nearest their house.

This is why so many IVF clinics have sprung up all over the country. Most of these don't have the requisite experience and expertise which established IVF clinics do, but they are able to lure patients in by extensive advertising - many of these clinics plaster small towns will full size bill-boards and take out full-page ads in local papers. They run "free camps" to get patients to sign up in the hundreds, to increase their sales funnel - and hundreds of poorly informed patients through their doors, to take advantage of this facility , which has now come to their doorstep.

The problem is that these are purely commercial enterprises, which are out to make the biggest bang for their buck. Their only metric is - how many IVF cycles can we do every month. They do IVF for anyone and everyone - whether they need it or not ! Ironically, this is the best way of improving IVF success rates - do it for young women who don't really need it in the first place. And once one of these couples gets pregnant, the word of mouth phenomenon starts kicking in, and sets up a positive virtuous cycle, which attracts even more patients.

Typically, these patients are not very educated or literate. They are in awe of the doctor, and accept whatever is suggested. In order to improve their success rates, these clinics use donor eggs and donor sperm indiscriminately - often without even informing the wife as to what they are doing !

We have no desire to compete with other clinics based on pricing - we think this is a mug's game, where the loser is the patient, because quality drops as  the doctor starts taking unethical shortcuts, in order to inflate success rates.

We try to educate our patients, so they are able to understand the differences between a good IVF clinic and a bad IVF clinic - and trust me, there is a world of a difference !

Sadly, most patients only find this out the hard way - but once they have burnt their money - and their fingers after failing an IVF cycle at these "bargain" IVF clinics, they no longer have any money left to do a proper IVF treatment cycle at a good clinic.

This is the biggest tragedy - and is a result of their ignorance, which can prove to be very expensive. We hope to immunise them against this with Information Therapy, but infertile patients are emotionally very vulnerable, and it's easy to take them for a ride !

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Wednesday, February 21, 2018

Review from a patient about Malpani Infertility Clinic

After getting cheated by doctors at local IUI and IVF clinics, we had lost trust in doctors.

But we took one chance and visited Malpani clinic for their opinion. When we met Dr Anirudha he was very patient and understanding. He spoke to us in a very friendly manner and asked us not to blame ourselves.He clearly explained the procedure at Malpani clinic and all the costs involved. 

He also explained that IVF takes time and we should not lose hope. He also explained the number of times we have to visit the clinic. This was very less as compared to other clinics and doctors which allowed us to go on with our usual lives. We were impressed with all the facilities and staff at the clinic and wanted to take another chance. 

When we started the cycle Dr Anjali would personally attend to us and do the scans. There were no assistant doctors involved. She did the egg retrieval process which went very smoothly and we did not face any difficulties. The nurses are very co-operative and patiently explained the medicines and injections to be taken.We were even refunded the unused injection charges.

Embryologist Dr.Sai kept us updated on the eggs retrieved and fertilised. He sent us photos of the blastocysts and explained quality of each of them. Due to this we were at ease that we have good quality blactocyst and our chances of getting pregnant are good.We froze the embryos and transferred one of them. Dr Anjali does the transfer and she is very experienced at it. We were given photos of the embryo which was transferred and before the transfer Dr. Sai also showed us the embryo to be transferred under the microscope. But unfortunately the cycle did not work.We were disappointed but Dr Anirudha called us personally and empathised with us. He gave us hope to keep trying. 

We did another embryo transfer and this time we were lucky and got pregnant.However after 5 months we suffered a miscarriage because of placenta previa bleeding and infection. We were heartbroken and completely shattered. We spoke to Dr Anjali when we were hospitalised and she gave us hope. 

After waiting for 4-5 months we again went for embryo transfer and luckily again we got pregnant. We still have some months to go to have a baby but the doctors and staff at Malpani clinic have given us plenty of confidence and hope that we will become parents one day. Dr Anjali and Anirudha have God gift to help childless couples like us Finally our advice to other couples is Don't give up hope..your day will come it just a matter of time. And if possible please visit the Malpani clinic for your problems.

Tuesday, February 20, 2018

Why it's a pleasure treating well informed patients !

A patient sent me this email

We are considering embarking upon IVF to have our 4th living child . We have a history of successful pregnancies (births 2008, 2010, 2012) mixed with miscarriages (3 in 2007, one in 2017). We want to expedite conception rather than trying for years more on our own. My AMH appears reasonable (21.6 pmol/l) and my CD3 FSH was 8.3; LH and estradiol, prolactin etc. were in normal range). We have approached two fertility clinics (one in Greece, one in the Czech republic, both well known) who have both recommended a hysteroscopy before proceeding. I do not feel that this is evidence-based practice. I have received recent serial ultrasounds, which showed normal uterus and ovaries - on CD14 endometrium was 10.6mm, trilaminar and had good blood flow; 22mm follicle to RHS (LH surge was later that day and CD21 progesterone confirmed ovulation). To my mind, the value of hysteroscopy is negligible in my specific case, despite having had 2 D&Cs for miscarriage in my past. I feel that any major issues are likely to have shown up in the ultrasounds - but I am interested to see if you agree! I also wish I could ask you my chances of having a baby - but I suspect that is far too complex a question. Moreover, with 3 previous successful pregnancies and just over a year trying for this one (with one miscarriage), decent AMH etc. I am going to remain very quietly optimistic on that front. Very best wishes, 

This is a patient who has done her homework and is clearly aware of all her options. She has used Information Therapy, so she can Say No to unnecessary procedures, such as hysteroscopy. She is not a doctor, but is very well read, and wants answers to her questions.

Many IVF doctors would not want her patient like her, because they would think she is too "demanding" - but she is the best kind of patient to treat, because she has realistic expectations of what an IVF doctor can do for her, and will not put up with an BS !

I am 28 and my girl friend is 33.We want to get married. Will we able to have a baby ?

I am 28 and my girl friend is 33.We want to get married, but my mother is worried about her fertility, because she is older than I am 

Can you help ?

While I can do some simple tests to check her fertility, I am very reluctant to do tests without  any good reason.

If you are both healthy and active, then the odds are stacked in your favour that you will have  no problems at all - the human race has proved to be quite efficient at reproducing itself !

If your girl friend is worried about her fertility because of her age, please share this with her.
Please test your AMH level (  read more at and 
your antral follicle count by doing a vaginal ultrasound scan ? Read more at
If these are normal, then we can reassure you that your fertility is fine.
It's not your calendar age which matters - it's your ovarian age !

Sunday, February 18, 2018

Can you suggest medications to enhance chances of conceiving ?

A patient sent me this email

Can you please check my semen analysis report  and confirm that this is normal

I checked it,and since it was normal, I replied,

Good, this is a normal report !

He then emailed back, saying 

Can you suggest medications to enhance chances of conceiving ?

I am confused !
Instead of being pleased that everything is normal,  why do patients still want doctors to prescribe medicines for them ?
Why can't they be patient and let Nature take its own course ?
Too much meddling can cause problems - and medicines do have side effects as well !

How do I calculate the age of my IVF pregnancy ?

A patient sent me this email

I had a query. I have conceived through IVF and ET was on Jan 6 th and my LMP was on Dec 20th.
I got my ultrasound done on 16th Feb and in scan it showed the pregnancy is 5 weeks 6 days.
If I calculate the growth of the baby from the date of the transfer, this seems fine, but if I calculate from the date of the LMP , it seems to be lagging behind.
I am completely confused - can you please help ?
This is a common problem, because IVF patients use their common sense and assume that doctors would calculate pregnancy dates based on the age of the embryo. Since they know the date of the embryo transfer, should the pregnancy be dated using this as the baseline.

However, doctors don't use embryonic age when dating a pregnancy in practise, because the clinical convention is always to use menstrual age !

Saturday, February 17, 2018

Is your IVF doctor ordering too many tests ?

Most patients are understandably wary about signing up for any surgical treatment options which a doctor offers,  because they understand that these treatments can be expensive and can have side effects. This is why they take a long time before providing consent for any invasive treatment. Unfortunately, they don't utilize the same skepticism when the doctor advises a panel of tests.
It is this unwillingness to question the need for tests which causes so many problems today. The fact of the matter is that too many doctors these days order too many tests. A lot of these tests are unnecessary, because they don't provide any useful information - they don't really change your treatment options, which is why they are pointless.
However, there is a lot of pressure on the doctor to do lots of tests, and this comes from many sources.
Ironically, patients will put often put pressure on the doctor, because they crave a diagnosis - they want to know what is wrong ! They are worried that if the doctor cannot put a label on their disease, they will not be able to treat it. This is why they're not happy when the doctor says, " All the test results are fine," , because they think this means the doctor is incompetent - after all, if he has not even been able to make the correct diagnosis, how can he be trusted to provide the right treatment ?
Doctors are also quite happy to play with the newest diagnostic toys, and when they attend a conference where a speaker waxes eloquent about the latest tests, they want to try it on their patients as well . After all, they want to remain on the cutting edge of medicine. The problem is that this results in their patients bleeding, because the conference talking about a new test is often out to promote it - either because he's the inventor, or because he has been " sponsored" to say good things about the test by the medical company which sells it. He talks at length about  how cool it is , and how it's helped him to find out the reasons for infertility in many couples, which other doctors have missed.
Doctors are still quite happy to use their patients as guinea pigs, because they want to try out new stuff ! They also believe - "What's the big deal about doing a test? Why don't I just go ahead and order it. It'll hopefully provide us with more information , and we may be able to use this in order to treat the patient's problem."  This is just wishful thinking - after all, the eye only sees what the mind knows.
And yes, doctors will often get cuts and kickbacks from the lab, and this incentivises them to order lots of tests, which is why so many of them subject their patients to "diagnostic panels" routinely - whether they actually need them or not. However, not all this over-testing is necessarily done with a bad intention.
The big problem is not the financial harm which this causes to the patient. The much bigger danger is that a lot of these brand new tests haven't been proven to be useful in clinical practice. Because they are new , we don't understand what their limitations are. They've not been subjected to controlled clinical trials to document they are beneficial in real life. However, the problem is that the moment you do tests , you're bound to find patients who have abnormal results. After all, that's what the purpose of doing a test is - to pick up abnormalities, so that's the easy bit. However, managing patients who have abnormal test results is exceedingly hard, because we don't have enough clinical data to do so intelligently !
Not only do these abnormal results cause a lot of anxiety in the patient, the doctor's knee-jerk reflex kicks in, and he wants to treat the so-called abnormality. This means his focus is now on treating the abnormal test result, rather than the patient. The moment he does this, he goes down the slippery slope of over-treatment. These tests are plagued with the problems of false positives - abnormal test results , which are completely unimportant and irrelevant. However , once a doctor gets an abnormal result, he triumphantly pronounces, "Ah, this is your problem. We found it!" The patient is also very impressed that he has such a clever doctor who's helped her to pinpoint what the problem is, and she's quite happy to take the treatment suggested, without realizing that this doesn't really increase the chance of her getting pregnant at all, because the test shouldn't have been done in the first place.
Unless patients learn to ask their doctor this simple question - How will the results of this test change my treatment options? - this problem is going to get even worse over time , especially with all the new DNA based genetic tests which are being introduced left, right and center - expensive tests which are looking for a patient to experiment on !
Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Friday, February 16, 2018

Genetic testing and the confused IVF specialist

Genetics plays an important part in reproductive medicine , and it's well known that the commonest reason for failed implantation is a genetic defect in the embryo . This is why it's very tempting to tell patients who have failed an IVF cycle to undergo genetic tests , and this issomething which IVF doctors do all the time . Sadly, most of them are pretty clueless about reproductive genetics , and they order all kinds of unnecessary tests , which they don't know how to interpret . Not only are these tests very expensive , they are completely unhelpful, because they don't really change the patient's treatment options. And because the doctor is confused , he ends up confusing the poor patient even more  !

The diagnostic equipment is expensive, and the genetic laboratories are happy to market these tests to IVF specialists, so they can generate revenue for themselves ( which they share with the referring doctor). This is why so many IVF specialists are quite happy to order the "latest" genetic tests for their patients - after all, isn't this the age of "personalised precision medicine" ? This also helps them to demonstrate to the patient that they are doing everything possible !

This is why IVF specialists end up ordering a wide range of useless tests , all the way from chromosomal testing ; to sperm DNA fragmentation ; to routine prepregnancy genetic carrier testing  for a host of rare disease.

This is why it's so important for patients to read the fine print before signing up for these expensive tests ! Thus, it is common to find many gene variants , but their clinical significance is not clear. Not only do abnormal results cause a lot of unnecessary mental stress, the truth is that it is not possible to exclude every disease risk utilizing these expensive genetic panels, no matter how "comprehensive" they are !

This kind of "spray and pray" routine machine-gun genetic testing  is much worse than looking for a needle in a haystack ! Because there are so many needles , there are tons of false positives, as a result of which patients end up wasting time and money while their doctor goes around chasing red herrings !

Do you suspect that your doctor is groping in the dark, and is covering up his ignorance by ordering too many tests ?

 Please send me your medical details by filling in the form at so that I can guide you !

Wednesday, February 14, 2018

Why IVF treatment does not increase your risk of getting cancer

Selecting a good IVF clinic

Making sense of your IVF blood results

A patient sent me this email

I am doing an IVF cycle, and my Day 6 results are as follows: E2- 1776 (great result) PO- 0.6 nmol/l LH 1.6 mIU/mL I am wondering if LH or Progesterone can be too low and should the cycle be cancelled. I am on Puregon- 300iu Menopur- 1 vial Orgalutran- 1 syringe Thanks

I am very pleased when patients are well-informed, and take an active and intelligent interest in their treatment !

Yes, the medical jargon can be quite confusing, and doctors don't make it easier, because they rarely bother to explain what's happening.

This is why the internet can be such a valuable resource for infertile women, who want to learn as much as possible about their IVF treatment

I reassured her.

 A high E2 ( estradiol) level means your ovaries are responding well, and this is a good sign. The LH and progesterone are meant to be low during superovulation , because you are being downregulated with Orgalutron ( a GnRH antagonist). You have had a text book response, and there's no need to cancel the cycle !

Why Hospitals need to prescribe Information Therapy to their patients?

Sunday, February 11, 2018

My doctor is insisting that I do IVF

A patient emailed me.
I have had 2 miscarriages. My doctor advised to take a HSG test. The radiologist reported that my tubes are open, but I may have "peritubal disease " because there is "ampullary coiling" and the "fimbrial ends are clumped" . My doctor is insisting that I go for IVF . Can you please provide a second opinion about my case.
This is has become a common racket. A HSG is a black and white shadow, and can only tell us if the tubes are open and closed. They cannot tell us if the tubes are working or not - and they definitely cannot tell us anything about what is happening outside the tubes !

However, radiologists have become very creative in their reporting today. They  provide a "detailed assessment" - and sacrifice precision and accuracy when embellishing their reports. While the report suggests that the radiologist was very thorough , she is actually playing guessing games , and is actually doing a disservice to the patient !

The reason this racket flourishes is because the referring doctor can then point to the "abnormalities" on the report, and push the patient into doing IVF, even though she doesn't need it !

We see the same sad story play out when doctors report vaginal ultrasound scans.The machines are very powerful, and they can pick up minor findings ( such as small cysts and fibroids) ,which are of no clinical importance. However,the sonographer then highlights these abnormalities - and makes them appear far more serious then they really are by playing games - by reporting the numbers in mm rather than cm , so they seem very large !

The doctor looks at this report, and then promptly advices laparoscopy and/or hysteroscopy, to "fix" the problems ! Sadly, this unnecessary surgery often reduces the poor patient's fertility  even more !

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Saturday, February 10, 2018

Thank you Dr Malpani !

                                                                                                                                                                Febuary 8, 2018
Dear Dr. Malpani,
The following is my testimonial to how you and your lovely wife and staff were instrumental in transforming my life by helping me become a mother to my lovely daughter.  In order to keep my information confidential, I am omitting the exact dates and keeping my identity anonymous.
My husband is diagnosed with a condition called ‘ maturation arrest’ which means that his testes does not produce sperms , no matter how well he ejaculates.  Hence, he is unable to ever become a biological father.
Although I always wanted to adopt kids instead of desiring to become a biological mom of any, his parents and he were not open to this option.  Hence, being the dutiful Indian daughter-in-law, I agreed to obtain my husband’s sister’s husband’s sperm and have an IVF procedure done in the country of where I reside.
The result was a success and I became the blessed mom of a healthy baby boy.
As my sister-in-law would occasionally taunt me as to how I ‘owe’ her this ‘favor’ of being a mom, I was against getting another child through her husband’s sperm again.
Fast forward 6 years later, my son began showing symptoms of severe anxiety should my husband and I ever leave him or die.  I realized that he was correct in that if my husband or I died, that he would be officially alone in this world without a ‘known immediate blood sibling’. Thus, I became open to having another child.
By then, I was 36 years old and my biological clock was ticking. I also didn’t know who else would be willing to be a sperm donor as asking my sil’s husband was NOT an option we desired.
We agreed that using an anonymous donor would be our best option.
After a few email exchanges to coordinate the timing of the treatment and our travel plans, we set off for Mumbai, where my husband and I were very well-received by Dr. Malpani’s warm staff of nurses.  Dr. Malpani, although super busy, didn’t waste any time in giving me his set of medicinal drugs and injections to make sure that my body would ovulate on time (as I had a history of polycystic ovaries).  His gentle, patient, yet honest way of communication was very much appreciated. I must also thank his lovely wife for her aid in checking that my uterus was fit enough to undergo the treatment with her infectious smile and easygoing personality.
After 2 weeks of using his treatment, I returned to his clinic to receive the IVF treatment where he would extract my eggs . so that he could fertilise them and then transfer the embryos inside my womb. 
While he was doing so, I remember keeping my Lord’s picture underneath my pillow and chanting his name while the supportive nurses smiled understandably. I had no doubt that this would work out as my Lord had come to me in a dream and told me that I would have 2 children. After the procedure, I was knocked out and fast asleep.  I remember someone calling out my name while I was in an unconscious state.  It was Dr. Malpani who had entered the room to exclaim, “Do you know how many eggs you had?” I groggily shook my head. He then said, “Thirteen!!!” (Honestly, I think that was the number although it could have one more or fewerJ) I understood that this meant that I was ‘quite fertile’ and that it was a good sign but at that time, I couldn’t care less as all I wanted to do was sleep!
Soon, we returned to the clinic where Dr. Malpani showed us the healthiest of the embryos and suggested we transfer one. However, we requested him to insert 2, and he agreed. Our dream of creating our ‘complete family’ for our first-born was soon going to be a reality!
While inserting the embryos back inside of me, I sang my Lord’s name again.  Dr. Malpani and his nurses  were very openly approving and accepting again of me behaving like an unconventional patient to which I thank them from the bottom of my heart. That day, I left the clinic with the potential to have 3 children.
After a few weeks, I was required to take a blood test at a nearby blood lab. When they called me a few days later, I was informed that I was pregnant! This news was not much of a surprise for me because I knew that the Lord’s words are always true. However, you can imagine our happiness when we found out!:)  One of the embryos vanished from my womb and the strongest one to survive could withstand the rest of my 1st trimester which was filled with bumpy riskshaw road rides, my son mistakenly kicking my stomach very hard while sleeping with me and a long flight back to my residing country.
Today I am a proud mother of a lovely son and a beautiful, strong daughter.
Without a doubt, Dr. Malpani and his wife and staff have been immensely instrumental and God send. My family and I thank you all profusely from the bottom of our hearts and wish you all immense happiness and love.

Friday, February 09, 2018

Dr Malpani, thanks for your website !

I just received this email
Let me tell you what a tremendously helpful website you have created. It gives HOPE to those who are in the same path. In fact I have read through most of your blogs and success as well as failure stories. Your blogs helped me logically understand what my own Gynac is following and empowered me with knowledge to ask the right questions and take INFORMED DECISIONS.
I now understand that the uterus usually is very receptive and readily accepts an embryo whether good or bad. It all depends now on how good the embryo is. So in my case if only I can manage at least one good embryo with other things remaining constant and if it works out then age related factors will be immaterial. The duration needed for it is something beyond anyone's control which I understand completely.
Also I understand though there are technologies like PGS/PGD, to check the chromosomal aspects, it still is invasive technique in which the embryo may or may not remain as good as it was before the test. Also there are other factors which may not work for the good embryo to implant.
Hope & patience is what I can work upon where nothing much is in my hands with regards to my age. My AMH last checked was about 2.45. I am aware with my age there is going to be a steep decline, thats where being informed and alert helps.

I shall let you know how we progress in the coming months.
Having someone who is an Expert in this field, to fall back on for advice, is such a huge guiding factor. Thanks to you & your team for contributing relentlessly to this section of society who consider doctors like yourself as God-send.
It's messages like this which make being a doctor so fulfilling ! 

Thursday, February 08, 2018

How to identify a bad IVF doctor

A patient just sent me this email.
This is my first IVf cycle. ET was done on 15.01.2018.. after that bhcg result on 29th jan was 112.. doctor did a repeat bhcg on 31st jan which was 144..again they called us on 6th feb the bhcg was 122 and in tvs no embryo sac was found.. doctor has asked to stop all medicines and wait for the periods..
Please suggest what could be the possible reason for it and if i will go for second IVf will it be successful..
This was my reply

The fact that the HCG did not double after 2 days means your pregnancy was not viable.
The doctor should not have given you false hope and make you wait unnecessarily like this.
Did the doctor give you a HCG injection after the transfer ? This can fool you !

Sadly, many IVF doctors continue to exploit the patient's ignorance, and the only way to protect yourself against this is by being better informed !

1. Once the HCG is positive, the doctor should repeat it again after 3 days, at which point it should double.. If it does not  do so, this means the pregnancy is not healthy.

2. The doctor should not give a HCG injection after doing the embryo transfer. This HCG will appear in the blood and the urine, and will fool the patient into thinking she is pregnant !

3. The doctor should not ask for a vaginal ultrasound scan until the HCG crosses 1000 mIU/ml. If the scan is done before this, it will not provide any useful information, as the pregnancy sac is too small to be seen on ultrasound scanning

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Wednesday, February 07, 2018

We have 2 Day 3 frozen embryos. Should we do a Day 3 transfer ? or a Day 5 transfer ?

A patient send me this email
Hi , We are trying our best to absorb the emotional trauma after going thru 1st failed IVF cycle.  We have gone for ICSI . All 5 eggs fertilised all are of grade A . The lab took 3 of them to blastocyst stage. 2 reached Day 5 and were transferred in a frozen cycle. Unfortunately this resulted in a BFN. We are left with 2 day 3 8-cell grade A embryos, and we are going for FET this month.. Should we try to take them to blasto stage , or should we transfer them as day 3 embryos. We are very confused now and upset - please help , as I love reading your articles.. 

I feel you should grow them to Day 5 before transferring. Yes, there is a risk they may stop growing in vitro, which means you may end up with no embryos to transfer, but if the embryos are going to arrest, it's best they do so in the lab, rather than in your wife's uterus ! What's the point of making your wife go through a traumatic 2ww  ?

Best of luck !

Tuesday, February 06, 2018

Why is it that my HCG always positive after IVF treatment , but I still don't have a baby ?

A patient sent me this email

I have had several IVF treatments since the last 2 years . Each time my pregnancy result was positive after 14 days , but thereafter it became negative.  My doctor says the embryos were Grade A each time, and calls this is a chemical pregnancy. Please advise if you have new methods or technologies where the  uterus can hold the embryos for longer . Or should I consider surrogacy ?  

Repeated positive pregnancy tests in many IVF cycles raises a red flag that the doctor is taking the patient for a ride.

The commonest trick is to give the patient HCG injections after the transfer, so that the pregnancy test will come back as positive ( because this HCG enters the blood stream , and is then excreted in the urine). The patient is excited that she is pregnant, and the doctor can claim success, saying that the fact that the HCG was positive means that his IVF treatment  worked.

Of course,  since this is  not really a pregnancy, the HCG levels will decline . The doctor will then say the patient miscarried, and some will even blame the patient for the pregnancy loss, by claiming that she did not rest properly, or ate something which caused the pregnancy to get dislodged ! The poor patient now starts blaming herself, and is quite happy to go back to the doctor and spend even more money, in the hope that in the next cycle, her uterus will not "reject" the embryo.

It breaks my heart when I see patients being taken for a ride by unscrupulous IVF doctors !

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Monday, February 05, 2018

There's a lot we don't understand about IVF !

IVF is seen to be a modern medical marvel  of scientific technology, and while it has allowed us to delight millions of infertile couples, the truth is also that there's lots about the IVF process which we cannot control, because we don't understand it very well.

Patients need to understand the limitations of IVF, so that they have realistic expectations of what we can do for them. Otherwise, every IVF cycle which fails causes needless heartburn,

Thus, we still cannot predict
- how a patient will respond to superovulation
- which egg will fertilise
- which embryo will cleave normally , and which will arrest;
- which embryo will implant.

A lot of IVF treatment is still trial and error, and patients need to come to term with this.

The problem is that doctors tend to overpromise, and when the cycle fails, patients do to pieces, and lose confidence in IVF doctors !

Wednesday, January 31, 2018

Mind games during the 2ww

A patient sent me this query
This is our first icsi cycle and am on 5th day of embryo transfer. Initially had cramps and it raised a bit more but since yesterday night I see no symptom and I am worried. Plus sometime bloating, my breasts has been so hard and am feeling I have been bit more aggressive than usual , am not on complete bed rest but tend to roam in home only . Medicines include progynova, ecoflora , folic acid and vitamin tablets , progesterone injection- aquagest alternative days and some progesterone vaginally daily two times. My skin is so so dry . I heard people saying tat u should get lower back pain or leg cramps but have cramps only on left side since the time of transfer plus yesterday I had bit abdomen pain also I sleep only three to 4 hours at night later I'll be half awake with the rush of thoughts being positive or negative. Am such a strong girl but now this is making me crazy. How to manage this. Sometimes I have extremely cold feet and since the day of transfer I have mild cough though am following the exact doctors it ok to experience all this. What is this symptoms leads to ? Should I be hopeful ?

Most patients find themselves going crazy during the 2ww, because they are a " little pregnant" ! They know they have an embryo inside their uterus, but are not sure whether this will become a baby or not, which is why they are full of doubts and worries .

Bulletin boards and forums are full of conflicting advice, which makes things even worse, and they don't know whom to trust !

Is having cramps a good sign ? or is not having cramps a good sign ? They find it hard to deal with this uncertainty, and will often end up browsing the web for hours on end, to try to make sense of what's happening inside them. They often drive their partner crazy as well, because he does not know how to reassure them !

The reality is that every woman's experience is different, and you can't jump to any conclusions, based on any of these symptoms. You just need to be patient, and wait for your beta HCG test result.

The good news is that your embryos are safe in your uterus, like a pearl in an oyster - nothing you do can harm them !


Tuesday, January 30, 2018

I am glad patients are learning to say No !

A patient send me this email
Sir, I m having a chocolate cyst in my left ovary of 3.6*2.8 CM and a normal right ovary . My first doctor advice me for immediate laparoscopy. I am trying for around 10 months. I changed my doc as I was scared of surgery. Can you help ?

I am glad patients are speaking up and refusing to subject themselves to unnecessary surgery !

With today's technology, infertile patients do not need a laparoscopy, but doctors continue to do this for them, without any good reason. Read more at

Such a tiny chocolate cyst will not affect her fertility, and unnecessary surgery would actually reduces her fertility as normal ovarian tissue is also removed along with the cyst wall, thus reducing her ovarian reserve.

Patients need to learn to speak up !

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Monday, January 29, 2018

How not to get ripped off by IVF doctors

This is a great article, at

Please do read it  - a lot of these malpractices are rampant in Indian IVF clinics as well.

I especially love the following paragraph !

Blinded by Pseudo Science

If a stranger down the pub told you the best way to get pregnant was to get a cheap bit of plastic and waggle it around inside your womb, would you believe them? Probably not. But if that advice came from a doctor and was given a fancy scientific sounding name, would you believe them?
Some fertility clinics offer add-on services as a supplement to the core treatment (i.e. in addition to a treatment like IVF). While these add-ons sound scientific, they have no evidence to prove that they improve your chances of getting pregnant. They won’t just harm your bank balance; some may even harm your chances of getting pregnant.
At the time of writing this, the following add-on services have no conclusive evidence that they improve your chances of getting pregnant:
  • Endometrial scratching
  • Embryo glue
  • Ultra-high magnification sperm selection (also known as Intracytoplasmic Morphological Sperm Injection or IMSI)
  • Multiple Ejaculation Resuspension and Centrifugation (MERC)
  • Fertility immunotherapy
  • Embryo time lapse imaging
  • Assisted hatching
  • Preimplantation Genetic Screening (PGS) – Not to be confused with Preimplantation Genetic Diagnosis (PGD), which is a legitimate treatment
This list is not exhaustive and new add-on services are being developed all the time. So, how do you stop yourself being taken in by one or more of these?


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