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 http://www.drmalpani.com/knowledge-center/infertility-testing/amh) and 
your antral follicle count by doing a vaginal ultrasound scan ? Read more at http://www.drmalpani.com/knowledge-center/articles/afc
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 ! Read more at http://www.drmalpani.com/knowledge-center/resources/book/chapter4b

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 www.drmalpani.com/free-second-opinion 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 www.drmalpani.com/free-second-opinion 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 www.drmalpani.com/free-second-opinion 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 www.drmalpani.com/free-second-opinion 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 www.drmalpani.com/free-second-opinion 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;
or
- 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 !


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