Friday, October 19, 2018

Making sense of your symptoms during an IVF cycle



Lot of patients get all kinds of symptoms during an IVF cycle.
Often this is during the cycle itself – for example, they may feel bloated; or have breast pain; or feel very irritable. And many of these symptoms become much worse during the 2 week wait, when the mind plays all kinds of games.  Everytime you get a backache, you are petrified that your cycle has failed and that your period is going to start.
It’s very hard to provide a biological explanation for these complaints. The reality is we often don't have a very good answer for a lot of these aches and pains.
Each woman experiences them differently and there is often no underlying common denominator.
However , we're not too worried or concerned about them, because we know they are common and are not medically sinister – they don’t suggest there's a complication , or anything's amiss.
All we can do is tell patients this is one those things they are going to need to learn to live with. Now, this doesn't mean that we're unsympathetic or we don't care – it’s just that we know that these symptoms are temporary and will pass.
We tell patients to take try home-remedies and take symptomatic relief to tide over this trying time, and not to worry about them.
I know this is easier said than done, but worrying needlessly doesn’t help at all, so it’s best to distract yourself and carry on with life !
Confused ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better?





Monday, October 15, 2018

What are your options after a failed IVF cycle ?



When an IVF cycle fails, patients want an answer to the most important question which is – What next? What are my options?
Now just because an IVF cycle has failed doesn't mean that you're never going to be able to have a baby, so please don’t start catastrophising or obsessing that all is lost.
This is why getting counseling before starting your IVF cycles , and doing your homework is so important, because this way you have realistic expectations of the IVF treatment, and you understand that often it takes time in order to achieve a pregnancy after IVF.
The first cycle failing is not the end of the world – it’s just the beginning of your journey to success !
The important thing is to analyze the cycle, so you can learn from it, and determine what went well, and what didn’t .
This is why sitting down and review your medical records your doctor is so important. The key here is the answer to a single question – What was the quality of your embryos?
It can be very helpful to get a second opinion , by sharing photographs of your embryos , as well as your IVF treatment protocol , with another IVF specialist , so that he can provide an alternative perspective.
He may be able to notice what the first doctor missed , so he can tell you what he can do better in order to increase your chances if you do another cycle.
Could you please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better?

Why frozen embryo transfers are better than fresh IVF cycles.



In the past, it was believed that the chances of getting pregnant were better when we transferred fresh embryos in an IVF cycle. 

After all, the word " fresh " itself suggests that these are vital , viable embryos, which are much more likely to implant, as compared to frozen embryos.

Patients would confuse the quality of frozen embryos with the quality of frozen vegetables and fruits kept in the refrigerator. This is why they would believe that these were stale, or not as healthy as fresh embryos.

In fact, this was true in the past, when we used slow freezing in order to cryopreserve embryos.

The technology for freezing embryos wasn't very good, as a result of which a lot of these embryos would die as a result of freezing and thawing them. 

However, the technology has improved dramatically, and we now use vitrification to freeze embryos. In our clinic, the survival rates are 100% , which means the pregnancy rates are better when we transfer frozen embryos,

This is true for many reasons.

1.  The endometrial receptivity is much better in a frozen cycle, because we can prepare the uterine lining optimally . In a fresh IVF cycle, the high dose of hormones used for superovulation can impair endometrial receptivity.

2. We can transfer only a single embryo at a time, so that the cumulative pregnancy rate remains high; and the obstetric risks of a multiple  pregnancy go down. This improves the live birth rate

3. It gives you more flexibility, and increases your options, because you can store your embryos, and use them for your second and third baby as well after a few years

4. The frozen thaw transfer cycle is much easier and less stressful, because there are no injections, and you just need to come to the clinic for 2 -3 scans !

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, October 13, 2018

Questions patients ask after a failed IVF cycle




IVF failure can be devastating  ! You invested all your hopes and money in this treatment which offered you the best chance of getting pregnant, and when it fails , this means that you're back to square one !

Patients have lots of questions after a failed IVF cycle.

How soon after a failed IVF can I try again?
What are my chances of conception after a failed IVF?
Is it possible for me to have a natural pregnancy after a failed IVF?
Why did my IVF cycle fail?

And all of these are perfectly reasonable questions, and step number one is to review your medical records with your doctor ,  to find out exactly what didn't go right – and what went well.

And if you don't have your medical records – especially photos of your embryos - this itself is a red flag, which means you need to get a second opinion to be able to determine what you can do in order to improve your chances in your next cycle.

There's no reason to go to pieces or to give up , just because one IVF cycle fails. The important thing is to learn from it , and then do what you can to improve your chances of success for your next cycle !
 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, October 11, 2018

What is the difference between an infertility specialist and an IVF specialist?




Lots of patients get confused about whom to go to when they want to baby, and most of them will go to the local gynecologist. This is especially true if they have had secondary infertility, and have already had a baby, and they assume the gynecologist will be handle to their infertility issues as well. After all, he delivered them the first time, didn't he?

                                And aren't gynecologists supposed to be specialists taking of women's health? Or they will go to a gynecologist for a regular check-up and will assume that he will be able to provide treatment, because these days every gynecologist calls himself an infertility specialist as well.

                                But the reality is, there is a big different between an IVF specialist and an infertility specialist. And a lot of so-called infertility specialists don't have the training, or the expertise, or the laboratory backup to be able to actually provide specialized care for infertile couples, which means these couples waste a lot of time and money.

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf to 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, October 10, 2018

What infertile couples need to do to make the right decisions


                             One of the hardest things infertile couples need to do is to make decisions. This is especially true when they are thinking about emotionally charged and sensitive issues as to whether to use donor eggs or not. After all , there are always multiple options, and the answers are never black or white. This can become  especially difficult if both husband and wife don't see eye-to-eye about the subject.

                                There really is no easy answer for this kind of impasse, and doctors are not always the best people to give guidance, because this is something that depends on your individual personal preferences.

                                It can be very helpful if both of you can talk to one person whom you both respect and trust. This could be one of your parents - or perhaps a coach ; a friend; a mentor; or a psychological counselor , who can help you discover the right decision for yourself. You need to find someone who is kind and empathetic, so you can unburden your heart,  and discuss the pros and cons of all the options which are available to you.

This path will give you peace of mind that you've made the decision which was right for you !

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf to 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 !





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Tuesday, October 09, 2018

What are my chances of getting pregnant with IVF ?



Most IVF patients want their doctor to give them a number in answer to this question , and they naively believe that the higher the number , the better the doctor !
The problem is that this number is quite meaningless . For one thing, it is usually an estimate – and before starting the cycle, it's not a high quality estimate, because doctors are forced to lump all their patients together in groups, according to their age.
The problem is that doctor  aren't fortune tellers, and we cannot predict how many eggs you will actually grow, or what the quality of your embryos will be, which is why this is a very  imprecise number. What’s worse is that lots of doctors will inflate the number, because they are trying to hook you into doing an IVF cycle with them, which means you can't even trust that number in the first place.
The reality is for an individual patient, any number - whether it's 20% or 40%, or 60% - is a meaningless number. For you,  either you get pregnant, which means it's a 100% success rate; or you don't get pregnant, which means it's a 0% success rate – there’s nothing in between !
A far better question you should be asking yourself is "If I do nothing, what are my chance of getting pregnant on my own ? How much does IVF increase those chances by? What's the delta?"
This way you have peace of mind that you've made a well thought-out decision for yourself.
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, October 08, 2018

The limitations of embryo grading in the IVF lab





Embryo implantation is an extremely complex process, and sometimes patients get frustrated when good quality blastocysts do not implant. But you need to understand that even if two blastocysts look exactly the same, their implantation potential can be very different.
                                Thus, for example, if we have two blastocysts , both of which have the same grade - let's say 3AA - but one came from an older woman with a poor AMH level whereas the other one came from a younger woman with good ovarian reserve, the  chances of the blastocyst which came from the younger woman implanting are much higher, even though both the embryos looks exactly the same.
This is one of the limitations of a embryo grading system - that it just captures how the embryo looks at a particular moment of time. It doesn’t tell us anything about the quality of egg this embryo came from, even though we know that egg quality plays a big role in embryo implantation, because it affects the genetic competence of the embryo.
After all, no one cares about how beautiful the blastocyst looks like on the day of the transfer – we are much more interested in its future potential of being able to grow in the uterus and implant – and we still can’t predict this accurately as yet.
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 !






Sunday, October 07, 2018

The donor egg decision



Over the last 30 years, we have treated lots of patients who have used donor eggs to have a baby. The vast majority of these patients are extremely happy with their decision, and many have come back for a second baby, in order to complete their family.
This is especially true when they have chosen that decision for themselves, for purely selfish reasons. They decided , "Yes, this is what we're happy to do, because I want to experience the joy of pregnancy and the happiness of bringing up a baby, and I'm not hung up about whose DNA it is."
                                On the other hand, there are lots of infertile couples who accept the option of donor eggs very reluctantly. Their justification is, "Well, what else can I do? This is the only option available. It's better than adoption, so I'm willing to compromise. I don't want to keep my husband unhappy," or, "My mother in law is forcing me to do it."
I don't think it's a good idea to use donor eggs if you think of it as being your second best option, or if it's one you're not comfortable with, and is being forced down your throat because of family pressures.
If you do that, you're not going to be happy, and you're not going to be able to bring up your child happily either.
You are the most important decision maker – and you need to make a decision you are at peace with !
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 !





Saturday, October 06, 2018

What are my chances of IVF success



Every patient wants to know what their chances of getting pregnant with IVF are going to be, because they need to know how much time, money and energy they are going to have to invest in pursuit of a baby.
Now the reality is that  it's not possible for us to give a very accurate answer before starting the cycle. We know that young patients have a better chance, and older patients have a lesser chance, but this is just an overall generalization, which applies to groups of patients – not to individuals.
And you are an individual and don't really care about what's happening to the other patients in my clinic - you only want to know what's going happen to you !
Please remember that our ability to give you an accurate number increases a lot more after we've done an IVF cycle, because we then have a much better idea of what your ovarian response is; how good your embryo quality is; and how your endometrium grows.
This means you need to be patient if you want a truthful answer. If you pressurize the doctor into giving you a number, we will trot a generic figure out, but it is going to  be extremely imprecise and inaccurate, and may confuse you.
So sometimes you need to ask yourself, "Why am I asking the doctor this question? Will the answer change my decision, whether it is 30% or 40% ? " And if it will not, then please go ahead and do your IVF with a smile !
But won’t the number help you to compare clinics, and decide which one to choose ?  I wish this was true, but in India it’s not, because every clinic claims a success rate of over 60% per cycle – even if their real success rate is 10% ! Sadly, there is no way for patients to verify these claims, which is a tragedy !
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 !

Friday, October 05, 2018

Infertility and irregular periods




Many infertile women have irregular cycles , and they know that this is the reason for their infertility, which is why they go to the gynecologist for treatment.
They doctor is happy to prescribe hormonal medicine to help their periods to become regular, but what they fail to realize is that just getting regular periods is not enough to help them to have a baby. They need to be very clear and focus on what their goal is.
If they just want regular periods, then taking hormonal tablets such as birth control pills is fine, but this is often just a distraction , and ends up just patching up the problem, and wasting time.
You need to understand that the irregular periods don’t cause infertility directly - the irregular periods are just a symptom of the underlying disease.
The reason for both the irregular periods and the infertility is anovulation - or not producing eggs. Now, giving birth control pills for forcing a menstrual bleed; or  inducing periods with tablets such as medroxyprogesterone acetate will help them to get regular periods as long as they take these medicines, but will not help them to treat the underlying condition, which means they will not ovulate or produce eggs. The problem will recur when they stop the medicines, which means they will be back to square one !
This is why they need to focus on inducing ovulation if they want to have a baby, and this is why patients need to be very clear and upfront with their doctor as to what their priorities are.
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, October 04, 2018

The IVF doctor’s bedside manner




Most doctors are great at talking sweetly to patients at the time of the first consultation, because they want to lure the patient in for treatment.  It’s easy to give patients lots of hopes and promises, and many patients like this , because it boosts their confidence , and they like the doctor’s positivity. They feel that being treated by a confident and optimistic doctor will improve their chance of getting pregnant.

But this has a downside and can backfire , because when the cycle fails , the patient feels completely let down. The same highly positive doctor becomes negative, and starts to ignore the patient; or refuses to answer calls; or blames the patient for the failure.

On the other hand, many IVF doctors are very scientific and rational. However, if you are cut-and-dried and stick to statistics , patients feel that you're not empathetic and are not able to connect emotionally with them, because you don’t understand their feelings.

They resent the fact that you're not being encouraging , or providing them with the confidence boost which they need to go ahead with the IVF cycle !

It's always a tricky balance, and both doctor and patients need to find a partner they are comfortable working with !

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, October 03, 2018

Should we change what we call infertility clinics?



Lots of infertility clinics call themselves infertility clinics because they treat infertile patients, and this makes a lot of sense. After all, cancer specialists treat cancer, and cardiologists treat patients with heart disease, so this is quite reasonable.
One the other hand, a lot of infertile patients object to this . They say that these are pro-fertility clinics, because they are helping patients to have a baby . Since they promote fertility, why do they continue to use such a negative name ? Why not call them  fertility clinics or pro-fertility clinics – wouldn’t this be much more positive and hopeful?
On one hand you could argue - what difference does a name make?
But  trying to encourage patients , and creating optimism by providing them with positivity makes a lot of sense.
Of course, the other choice is to call yourself an IVF clinic, because that's the primary treatment which we offer. But because IVF covers so many other treatment options as well, perhaps calling ourselves Malpani Fertility Clinic clinic would be the best option !
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 !





Tuesday, October 02, 2018

Older patients and IVF



A lot of older patients are very reluctant to do IVF , because they feel they will not be able to make good parents.
They believe that because they are older, they will not be able to run around after their kids. They worry is that by the time their kids grow up, they will have become very old, and won’t be able to provide for them.
They also wonder whether other children will laugh at their kids in school , simply because they are the age of their friend’s grand-parents.
 And I think this anxiety is completely misplaced, because older parents actually make far better parents.
They've spent a lot of time and energy thinking about this decision of whether or not to have a baby, which means when they do become parents, these children are the apple of their eye. They spend a disproportionate amount of time, love and attention on  their children,  who grow up to become excellent citizens.
Yes, they may not have as much physical energy as younger parents , but they have a lot more money to spend, which means they can offer their children the finest upbringing available . Not only do they give  them the best education, they also take them for the best holidays, and provide them with a lot intellectual stimulation and opportunities which younger parents can't do.
Equally importantly, they are much more mature, and are happy to let their children find their own space in this world – they don’t burden their children by forcing them to live upto their own unfulfilled dreams.
Finally, life expectancy is increasing all over the world, and they will most probably be able to see their kids grow up and become confident adults , even if they are more than 50 years old today!
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, October 01, 2018

Symptoms during an IVF cycle



Lot of patients get all kinds of symptoms during an IVF cycle.


Often this is during the cycle itself – for example, they may feel bloated; or have breast pain; or feel very irritable. And many of these symptoms become much worse during the 2 week wait, when the mind plays all kinds of games.  Everytime you get a backache, you are petrified that your cycle has failed and that your period is going to start.

It’s very hard to provide a biological explanation for these complaints. The reality is we often don't have a very good answer for a lot of these aches and pains.

Each woman experiences them differently and there is often no underlying common denominator.

However , we're not too worried or concerned about them, because we know they are common and are not medically sinister – they don’t suggest there's a complication , or anything's amiss.

All we can do is tell patients this is one those things they are going to need to learn to live with. Now, this doesn't mean that we're unsympathetic or we don't care – it’s just that we know that these symptoms are temporary and will pass.

We tell patients to take try home-remedies and take symptomatic relief to tide over this trying time, and not to worry about them.

I know this is easier said than done, but worrying needlessly doesn’t help at all, so it’s best to distract yourself and carry on with life !

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
and this will help you understand what you are going through !

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 !







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