Wednesday, September 19, 2018

Answers after IVF failure



When an IVF cycle fails, patients want answers !
It’s natural to feel disappointed, sad and angry, because you are now back to square one – even after spending all that time, money and energy ! And what happened to all the reassurances which the doctor offered, saying your embryos were perfect and that you were “definitely going to get pregnant” ? Was it all just a lie ?
Please take a break and give yourself time to grieve and recover ! The truth is that many women who have had a failed IVF cycle will be successful on a second or even a third cycle. While success can never be guaranteed, some of the problems which were discovered during the IVF treatment can be corrected , to help make the next cycle more successful.
This is why you want your doctor to be able to tell you exactly what went wrong, so you can fix it and have a baby in your next attempt. Unfortunately, this is surprisingly hard to do, simply because there are so many biological variables in an IVF treatment cycle, that it's not always possible to pinpoint what the exact problem was.
Not only is every patient unique, the problem is that IVF cycles in the same patient will also vary from one month to another. This is why it’s very difficult to extrapolate based on the results of just one cycle.  However, patients don't understand that biological systems are messy, that we don't have the same kind of accuracy and precision which we do when dealing with computer programs and bank accounts.
In any case, far more important than asking, "Why did the cycle fail?", a far better quality question is, "What did we learn from this cycle?" And even more importantly, "What can we do differently in the next cycle to maximize our chance of getting pregnant?"
The truth is that if you ask good questions, you're likely to get good answers ! And because IVF technology has improved so  much, even if we can’t always identify problems, we are surprisingly good at finding solutions by bypassing problems in the IVF lab  !
You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
and this will help you understand more about the IVF process, and why it fails sometimes.
Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






Tuesday, September 18, 2018

IVF success rates, statistics and probability



One of the major problems which plagues IVF treatment is the uncertainty surrounding it , because you can never be sure whether your IVF cycle is going to work or not. This is where the concept of probability is so important.  Patients need to understand what their chance of success are, so they can decide how many times they want to try IVF.
The trouble is that's very hard to apply probability statistics to IVF for two reasons. One is because it's so personal – after all, the success rate is not just a number ! It's something which affects your entire life, which is why  it's very hard to view it objectively in a detached fashion.
The other problem is that the law of small numbers applies. Statistics aren't very reliable when they are applied to small numbers , and this is a big problem with IVF cycles, because it's very hard to draw conclusions based one patient's experience with one or two cycles.
Finally, the fact that there are so many biological variables which affect the results of IVF makes interpreting these numbers extremely hard - not just for patients , but for doctors as well.
This is why both doctor and patient need to sit together , so they can decide what's right for the patient.
You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
and this will help you make better decisions !
Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Monday, September 17, 2018

Orgasms during an IVF cycle




It's not uncommon for IVF patients to have an orgasm during their IVF cycle ; and during the two-week wait after the embryo transfer. This is often involuntary , and happens during their sleep. They wake up , and many start to panic , because they are worried that the orgasm is going to harm their embryo.  Their fear is that the uterine cramping will cause the uterus to expel the embryo.
This can be quite embarrassing, and they are ashamed to discuss this with their doctor.
The reason for the orgasm is because of the increased blood flow to the clitoris during this time. Your hormonal levels of estradiol and progesterone are very high at this time, and this increases pelvic vascularity . This results in  pelvic congestion and clitoral turgidity , and minor mechanical stimulation could trigger an orgasm.
Please don't panic or worry if this happens. Your embryo is safe in your uterus, just like a pearl in an oyster. It’s not going to get harmed because of the pelvic contractions. Please don’t feel guilty or worried that this has reduced your chances of success.
You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
so you can stop worrying !
Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






Saturday, September 15, 2018

The cost of IVF failure



Many patients are understandably worried about the cost of an IVF treatment cycle , because it's so expensive.
However, one of the things you need to factor in is the cost of IVF failure. What does  this mean?
It’s tempting to cut corners and go to the cheapest clinic ; or the one closest to you, even if it doesn’t have much experience or expertise. However, the risk of your IVF cycle failing is much higher in these clinics, and if your IVF cycle fails, you will actually end up spending much more !
Not only will you have wasted your money on your first cycle, you will have to pay more for a second cycle – and you'll have wasted a lot of precious time and energy as well. Even worse, you may abandon the idea of IVF treatment altogether, because your confidence levels - both in yourself as well as in IVF doctors - will go down considerably.
That's why you need to consider the total lifecycle cost of doing IVF treatment - the total cost you will have to pay in order to have a baby. This may require multiple cycles, and you need to factor in the money you spend; your  emotional energy; and the time as well, because the longer you wait to have a baby, the older you're going to be, and the less you're going to be able to enjoy being a parent !
You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
and this will help you reduce your risk of IVF failure !
Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






Friday, September 14, 2018

Why making IVF decisions can be so hard



Sometimes the medical decisions which infertile patients need to make can be very simple , because there really aren't too many options. Thus if your tubes are blocked , your only treatment option is IVF , so your only decision is which IVF clinic to select.
On the other hand, you may find that you have lots of treatment options , and you then need to decide what's right for you. Thus, if you are older, you may be able to get pregnant with your own eggs, but you know that your chances of getting pregnant with donor eggs are much higher .
You are not sure which is the right decision. Should you go for donor eggs, because it has a higher success rate ? Or should you continue trying with your own eggs because you want to transmit your own DNA to your child?
These are not decisions a doctor can make for you - you need to make them for yourself, and they can be very tricky. It can be even harder when both husband and wife are not on the same page , and they disagree with each other . You will have to sit and discuss this thorny issue, until you find a decision which both of you are pleased with.
You need to use your head , but you need to listen to your heart as well, so take your time when making such an important decision !
You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
and this will help you make better decisions !
Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !







Thursday, September 13, 2018

Why IVF patients need to make their own decisions



One of the hardest things for IVF patients to do is to make decisions. When their IVF cycle fails, they are not sure whether they should use their own eggs; or donor eggs; or donor sperm; or surrogacy. It can be very confusing , and because patients are not medical experts , they want a doctor to make these decisions for them.
However, these decisions shouldn't be made by doctors , because it's such a personal choice , and will affect the rest of the patient's life. Yes, it's very easy for the doctor to tell the patient what to do, but the patient cannot abdicate this responsibility and allow the doctor to make these decisions.
The job of the doctor , as a medical professional, is to make sure that he offers all the choices to the patient , and makes sure that the patient does not make the wrong choice -  a choice based on incomplete or incorrect medical information . However, the truth is that   there are no right or wrong choices – whichever choice the patient makes is the right choice for her. Patients have to decide for themselves, and the job of the doctor is to be supportive and offer non-directive counseling, so they can do what they feel is right for them.
The reality is that it can be very hard to make some of these decisions. Because of the dramatic advances in reproductive medical technology, there is a dazzling variety of choices in front of the patient , and this can be very confusing. Patients are often paralysed because they don’t know how to select the right one. They can use donor eggs, donor sperm, donor embryos , or do surrogacy. There’s a wide choice of mix and match options, and patients are not sure what to do,
They expect the doctor to make this decision for them, because he is the medical expert, but often these are very personal preferences, and the doctor is not a mind reader. That's why it's the patient's responsibility to explore all the options, understand the medical facts , and then apply their own mind and decide , based on their personal preferences , what to do.
You have to use your head and you have to use your heart as well, because you need to live with the consequence of the decision. The reality is that the decision you make is right for you. There is no right or wrong decision. Every decision has pros and cons, you need to weigh this, you need to be systematic about it, and more importantly you need to have peace of mind that you've thought about it and made the decision which both your head and heart said was right for you.
You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
and this will help you make better decisions !
Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






 

Wednesday, September 12, 2018

Bouncing back after a failed IVF cycle



When an IVF cycle fails, patients want an answer.
It’s natural to feel disappointed, sad and angry, because you are now back to square one – even after spending all that time, money and energy ! And what happened to all the reassurances which the doctor offered, saying your embryos were perfect and that you were “definitely going to get pregnant” ? Was it all just a lie ?
Please take a break and give yourself time to grieve and recover ! The truth is that many women who have had a failed IVF cycle will be successful on a second or even a third cycle. While success can never be guaranteed, some of the problems which were discovered during the IVF treatment can be corrected , to help make the next cycle more successful.
This is why you want your doctor to be able to tell you exactly what went wrong, so you can fix it and have a baby in your next attempt. Unfortunately, this is surprisingly hard to do, simply because there are so many biological variables in an IVF treatment cycle, that it's not always possible to pinpoint what the exact problem was.
Not only is every patient unique, the problem is that IVF cycles in the same patient will also vary from one month to another. This is why it’s very difficult to extrapolate based on the results of just one cycle.  However, patients don't understand that biological systems are messy, that we don't have the same kind of accuracy and precision which we do when dealing with computer programs and bank accounts.
In any case, far more important than asking, "Why did the cycle fail?", a far better quality question is, "What did we learn from this cycle?" And even more importantly, "What can we do differently in the next cycle to maximize our chance of getting pregnant?"
The truth is that if you ask good questions, you're likely to get good answers ! And because IVF technology has improved so  much, even if we can’t always identify problems, we are surprisingly good at finding solutions by bypassing problems in the IVF lab  !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






Tuesday, September 11, 2018

Why can't the doctor tell me why my IVF cycle failed ?



When an IVF cycle fails, patients want answers. What went wrong ? What can we do differently the next time?
Part of the problem is it's very hard for doctors to provide precise answers, simply because biological systems are so messy. After all, the law of small numbers applies , and it's very hard to extrapolate or give definitive answers based on just one single cycle, simply because there's so many variables.
It’s not as if we are trying to hide information from the patient, but the honest truth is that we really don't know why a given IVF cycle fails – or even why it succeeds, for that matter ! ( Of course, when the IVF cycle succeeds, everyone is over the moon, and no one asks why everything went off perfectly , because this is what they hoped for an expected).
The problem is that doctors are upfront and honest , and tell patients we don’t really know why the cycle failed, they get very upset . They that the doctor is either completely clueless , or is not hiding information .
They are unhappy, because they naively believe that medicine is a science, which is they expect precision and accuracy from the IVF specialist. After all, isn’t he supposed to be an expert ? What kind of expert cannot answer such simple and basic questions ?
Sadly, biological systems are not engineered by doctors, and patients need to be aware of the uncertainty which plagues IVF treatment before they actually start their IVF cycle.
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, September 10, 2018

Engineers, programmers , analysts and IVF cycles



Engineers , business analysts and computer programmers find it very hard to understand why perfect IVF cycles fail. After all, didn’t the doctor transfer a Grade A blastocyst into a beautiful endometrium ?  Why didn’t the embryo become a baby – isn’t that what embryos are supposed to do ?
What went wrong ? Given their educational background, they demand a logical and rational explanation for why the cycle failed - a root cause analysis.
When doctors tell them the truth and say, "We cannot provide an accurate answer," they get very upset,  because they're so used to mathematical precision and certainty . They forget that biological systems are very messy. Not only is there a lot of variability from cycle to cycle, there's also lot of variability from patient to patient, which is why IVF cycles are neither repeatable or predictable.
Finally, remember that a lot of what we do in medicine is based on anecdotal successes as well as personal prejudices. Since the numbers are small, probability estimates are unreliable, which is why it's very hard to be precise.
It's important that patients not have unrealistic expectations about some of the answers which we can give them. It's not as if we are trying to fudge, but the truth is that it's very hard to be accurate when dealing with biological systems.
However, rather than take the time and trouble to explain the complexity to patients, many IVF doctors will take shortcuts by coming up with fanciful explanations – many of which are sprinkled with meaningless biological jargon ( such as “failed implantation”) – in order to placate their patients. Sadly, these answers are rubbish – but patients are very impressed. The irony is that the doctor can earn a lot more money by doing expensive and pointless tests, such as the ERA ( endometrial receptivity assay ) , even though these tests are a waste of time and money. Read more at https://www.drmalpani.com/knowledge-center/articles/why-the-new-expensive-endometrial-receptivity-tests-are-useless
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !







Sunday, September 09, 2018

Dr. Google and the IVF patient



Lots of IVF patients will go to Dr. Google to get information because IVF doctors are too busy to answer their questions.
However, over time, many stop doing this . This is partly because they get very confused by what they find, because a lot of the information available online is contradictory – and plenty of it is wrong and misleading. They don't know whom to trust, and therefore end up distrusting everything they read !
Also, they find that doctors get very upset when they pull out information from the Internet. Many doctors treat online information with contempt, by saying that everything on the Internet is all rubbish !
Finally, husbands also get quite irritated because their wives spend so many hours obsessing over what they read on the Internet. They believe that a little knowledge is dangerous, and that patients should not try to play doctor. Their attitude is that patients should leave medicine to the IVF specialist, rather than try to become an IVF expert themselves !
However, I think it's important that we not throw the baby out with the bathwater. As with everything in life, there is a golden middle path !
It’s very helpful to use the internet to get information, but the secret is to go to reliable websites. These include sites such as www.drmalpani.com and www.ivfindia.com , which simplify information, so the patient understands what is happening, and can have an intelligent discussion with their doctor. These are sites you can trust , because they been published by us – and we are a reputed IVF clinic !
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, September 05, 2018

The second IVF cycle



There's usually a world of a difference between the  first IVF cycle and the next one.


For the first cycle, most patients are very excited , because she knows that IVF gives her the best chance of getting pregnant and she’s eagerly she's looking forward to having a baby at the end of it.  Yes, there is some anxiety and nervousness , because of all the myths and misconceptions that surround IVF , and she's scared about its side effects. However, because she’s very hopeful that it's going to work, she finds it easy to cope with these. After all , if every patient didn't think the cycle was going to work, no one would ever start an IVF cycle in the first place !

However, when the first cycle fails, starting a second cycle sometimes can be extremely hard . You have learned through bitter personal experience that IVF failure is a reality, and there are no guarantees that it will ever work, even if you do it again. This uncertainty can drive you crazy !

On the other hand , because this is your second time around, you're much better informed and you understand exactly what's involved because of your experiences. You know that IVF is safe and carries no medical risks , which can give you a lot of peace of mind.

Finally, the first cycle can tell the doctor a lot about what want right medically , and what didn’t. He can use this information to optimize your treatment protocol in your next cycle, and thus maximize your chances  in the next IVF cycle. This is why your chances of getting pregnant will progressively improve, the more the number of cycles you do.

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

Tuesday, September 04, 2018

Why did my eggs not ovulate ?



Many infertile patients ask me questions through our IVF Chatbot on www.ivfindia.com and our Free Second Opinion form on www.drmalpani.com
Based on the quality of their queries, I worry how about poorly informed they are . Why are IVF doctors not bothering  to educate patients at all ?
Thus someone just asked me, "My doctor is not being able to do an IUI because my egg is not ovulating.”
Now this patient is trying to do her best to understand the problem. But unfortunately doctors aren't being very transparent and open . They aren’t taking the time or trouble to explain what’s happening to their patients. And sometimes doctors use so much medical jargon that patients get even more confused.
In order to do an IUI, the patient needs to grow a follicle, and the IUI is done when it ruptures ( this is called ovulation). In her case, the follicle did not rupture, which means the egg was not released and the IUI could not be done. This is called Luteinized Unruptured Follicle ( LUF) syndrome.  You can read more about this at  blog.drmalpani.com/2010/08/luf-syndrome-and-infertility.html
It’s possible to treat this, either by triggering ovulation using a higher dose of HCG injections. However, for some women , even this doesn’t work. In that case, the right treatment option is IVF, because we are extracting the egg directly from the mature follicle and fertilizing it in the lab . However, this is an expensive option !
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, September 03, 2018

What is a test tube baby ? Common questions from IVF patients



Since I answer a lot of questions online and provide a fee second opinion, I get lots of queries from patients.
I'm going to start answering some of these on my blog, so that other patients can benefit from my answers.
One of the commonest ones include -  What are the charges of a test tube baby? What is a test tube baby? What are the steps of a test tube baby?
A test tube baby is the lay person's word for IVF, and not only can you read an entire comic book about IVF on our site at www.ivfindia.com, you can also get all your questions answered.
Before you start an IVF cycle, it’s very important that you're well informed , and have done your homework, so you have realistic expectations from the IVF cycle.  In a perfect world, your doctor would have the time to answer  your questions, but sadly, this is not true, which is why you are going to have to spend effort and energy in doing this yourself.
It’s well worth doing this, because this knowledge will allow you to choose the right test tube baby clinic, so you don't get taken for a ride !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Sunday, September 02, 2018

What are the risks of PCOD ?



One of the commonest questions which patients ask me is - What is polycystic ovariandisease (or PCO, also known as PCOD and PCOS? ) And what are its risks ?
This has now become a very common diagnosis, and is made by gynecologists, dietitians, skin specialists and GPs as well.  The diagnosis is made typically for young girls, who are worried because they irregular periods; are a little bit overweight; or have acne or some oily skin. Doctors order a panel of expensive blood tests ( which measure hormones levels such as FSH, LH, DHEA, testosterone and AMH), and these often turn out to be abnormal in these girls.
The problem is that once they get this diagnostic label , they go to Dr Google , which scares them about the increased risk of PCOD patients being infertile;  getting endometrial cancer; and developing diabetes.
Please remember that PCOD is a common problem, and the good news is that it's eminently treatable, so you don't need to start panicking. Often all you need are simple lifestyle changes, such as losing weight, to correct your hormonal imbalance.
And in any case, there are  lots of simple treatment options to treat this if needed ,  so you don't need to lose any sleep over it !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






Saturday, September 01, 2018

Why bed rest after your embryo transfer is bad for you



Most IVF patients are petrified that they will do something which will reduce their chance of getting pregnant after their embryo transfer .
They imagine that their fragile precious embryo is floating in their uterus , and if they eat something too hot or too cold , or go through a pot hole, they will dislodge the embryo and end up killing it. This is why they are always on tenterhooks after the transfer.
A lot of these misconceptions are compounded by old wives tales , which advice patients to take bed rest after an embryo transfer , so that it does not “fall out” !
Now, this is all rubbish. There's nothing you can do to increase the chances of the embryo implanting, which also means there's nothing you can do to decrease the chances either. Embryo implantation is an in utero biological  process , which we cannot influence.
Please stop thinking of yourself as a patient. You're a healthy woman , who has done IVF in order to get your pregnancy started , which means there’s nothing unnatural or artificial about it !
All we are doing is replicating what would normally have happened in your bedroom ! In IVF, what's not happening in your bedroom is being done for you in the IVF lab.  Remember that whether the embryo spends five days in our test tube , or it spends five days in you’re your fallopian tube, once it's reached the uterus, it's safe like a pearl in an oyster !
Unnecessary bed rest is actually bad for you, because it just needlessly increases your stress levels. An idle mind is a devil's workshop, and you keep on brooding about what's happening to your embryos inside you. This increases your stress levels, and makes the waiting seem even longer than it is !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





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