Monday, March 18, 2019

New research shows that PGT does not improve pregnancy rates

Making difficult decisions - a guide for IVF couples

Repeated IVF failure versus recurrent implantation failure


A failed IVF cycle causes a lot of heartburn . It's not just patients who get disheartened and disappointed, and doctors also wonder about what they can do differently the next time to improve the chances of success.

We need to differentiate between repeated IVF failure versus recurrent implantation failure. Recurrent implantation failure means good quality embryos ( usually, a total of 4 top quality blastocysts) have been transferred in the uterus over 3 cycles and yet have failed to implant.

There are many other reason for IVF failure - for example, because the embryos were of poor quality. If we know what the reason is, then this is something we can focus on and try to correct. Thus, if the reason for poor quality embryos is poor quality eggs because of advanced age, we can address this issue by suggesting the use of donor eggs.

However, for patients where we have transferred top quality embryos into a receptive endometrium, but the embryos stubbornly fail to implant, then it becomes a much more complicated issue , because we cannot determine why they are not implanting.

The reality is that we will have to call these unexplained implantation failures, because implantation is still a biological black box which we cannot control !

We need to understand our limitations , and this is why documenting the quality of embryos ( by sharing photographs with patients) is so important for determining what the next steps should be !

What to find an IVF clinic which respects your time and intelligence ?
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Saturday, March 16, 2019

Why sophisticated IVF patients love technology - and how this can hurt t...

Why IVF babies are at increased risk as compared to normal pregnancies

A lot of people worry that IVF babies are abnormal as compared to babies made in the bedroom . This is often based on press reports which say that IVF increases the risk of babies having medical problems . This is true , but we need to understand why !

This increased risk is applicable only when IVF gives rise to a multiple pregnancy . It's well known that multiple pregnancies increase the risk of prematurity, and preterm babies are at a much higher risk of a whole host of medical problems, such as retinopathy of prematurity, cerebral palsy or mental retardation. 

This clearly means that it's not the IVF which increases the risk, it's the fact that it's a multiple pregnancy . Now the risk of a multiple pregnancy is higher in IVF clinics which are irresponsible, and transfer more than one embryo at a time. This is why all good IVF clinics suggest that patients transfer only one embryo at a time.

The good news is that IVF singletons have exactly the same risks as bedroom singletons, and the chances of their having medical problems is not increased at all !

What to find an IVF clinic which respects your time and intelligence ?

Tuesday, March 12, 2019

A free solution for reducing IVF stress!

When IVF is bad for you !

While IVF can be a very effective treatment option for infertile couples,  the sad truth is that it sometimes causes more harm than good.

Thus, many IVF doctors push unproven and untested tests and treatments on their patients. These are disguised in the garb of being the "latest technological advance", but actually serve only to improve the  clinic's profits, and not the patient's pregnancy rates. However, patients are desperate, and unethical doctors are happy to take advantage of the patient's vulnerability.

Over the last 30 years, we have seen many of these "advances" come and go. They were introduced with a lot of fanfare, but died a slow death, when it was learned that they did not help to improve IVF success rates. Sadly, these caused a lot of harm to patients who served inadvertently as "guinea pigs" !

The list is long - and doesn't seem to get any smaller, because there will always be new solutions to take the place of the discredited ones.

These include:
 - treatment of "luteal phase defect" - a diagnosis which has turned out to be a mirage
- Growth Hormone treatment for poor ovarian responders
- Endometrial scratching
- Coculture
- Laser assisted hatching
- Immune Therapy
- Testing for NK cells

Patients need to become more proactive, and not get carried away by stuff, just because it is the "newest and latest". In fact, in medicine, old remains gold, because it has stood the test of time !

Want to find an IVF clinic which respects your time and intelligence ?
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Monday, March 11, 2019

Bed rest is bad for IVF patients.

One of the myths which continues to plague IVF patients is that of bed rest. This has been propagated for decades, and everyone tells them to rest after doing a transfer. It's often not just their mother-in-law and friends - it's often the doctor ( and nurses) as well ! 

This makes absolutely no sense , because bed rest is actually bad for patients. It adds to their emotional stress , because an idle mind is the devil's workshop. When they rest in bed, they think all day about what could potentially go wrong, and how they will cope if the pregnancy test comes back as negative. It's bad for their physiology as well, because their backs hurt ; their muscles  become weak , and blood flow to the uterus actually decreases.

This is why we encourage patients not to take any bed rest at all, and to continue to lead a normal life ! After all, they aren't really patients - they are healthy women , and we are just helping them to kick-start their pregnancy ! Once the embryo is transferred into the uterus, it is as a safe as a pearl in an oyster. Embryo implantation is a biological process, and will progress normally and naturally, irrespective of physical activity.

What to find an IVF clinic which respects your time and intelligence ?

The misdiagnosis of PCO

Wednesday, March 06, 2019

New research shows that PGT does not improve pregnancy rates

The latest craze in IVF clinics in India today is to promote PGT ( preimplantation genetic testing). This is an expensive test, which allows us to check the chromosomes of an embryo, so we can transfer only the chromosomally normal embryos back into the uterus.

Now, logically, this makes a lot of intuitive and scientific sense. After all, what's the point of transferring genetically abnormal embryos into the uterus. And if we have a test which allows us to test whether or not the embryo is chromosomally normal, then doesn't it make sense to use it? Why should we worry about the cost if it improves pregnancy rates ?

Sadly, not only does it add to the costs, it also does not improve success rates, as proven by this paper published in the respected journal, Human Reproduction, in Sept 2018, from one of the world's leasing IVF academic centers in Brussels.

If your doctor pushes you into doing PGT, or suggests that it will improve your chances of getting pregnant, please share this reference with him !

Iatrogenic infertility

Monday, February 25, 2019

Making sense of IVF treatment

LH as the villain in IVF protocols.

The purpose of an IVF superovulation protocol is to help you grow lots of follicles, which is why we use gonadotropin injections which contain 2 hormones - FSH and LH.
One of the problems is that the LH hormone can sometimes play the role of a rogue.
If there is an early LH surge, the follicles can rupture too early , and we may not be able to pick up an egg at all.
This used to be a major problem in the past, which has now been solved by using either GnRH agonists, or  GnRH antagonists, which prevent these LH surges.
Sometimes the LH surge may not be enough to cause premature follicular rupture, which means we can still collect eggs. However, a minor LH surge can cause premature luteinization , and as a result of the high progesterone levels this causes on the day of egg collection, the endometrial receptivity may be compromised.
This is why many clinics are now freezing all the embryos, so we do not transfer embryos in the fresh cycle at all. We can then transfer the frozen embryos in a follow up cycle , where we can prepared the endometrium for optimal receptivity using exogenous hormones such as estradiol.

Find this confusing ? You can't afford to remain clueless ! The good news is that it's easy to figure out  by downloading  the IVF comic book free at <>

What to find an IVF clinic which respects your time and intelligence ?

Sunday, February 24, 2019

Embryo pooling for patients with poor ovarian response

The commonest mistake IVF patients make

A lot of IVF patients can be exceptionally naïve . They believe that all IVF clinics are created equal, which means the success rates in all clinics are the same. But this is not true, and new clinics , or clinics which are part of corporate chains are often not able to provide the kind of personalized attention and handholding which small boutique clinics can.

And this is why it's so important that patients do their homework before actually signing up for an IVF cycle.

At the time of the first consultation , the IVF doctor does his best to get you to sign  up and is happy to take your money away from you, but you really don't know what you're getting into if you don't ask the right questions !

The way to find out if they are they going to able to provide high-quality care is by asking 3 simple questions - Do they routinely provide photos of embryos? Do they do blastocyst transfers routinely for all their patients ?  Do they freeze spare embryos routinely ?

If you don't know the answers to these questions - or if you don't know what a blastocyst is - then this in itself is a red flag, because unless you do your homework you're not going to able to make out whether you're making a mistake when selecting an IVF clinic !
The good news is that it's easy to figure this out  !

You can download the IVF comic book free at <>

What to find an IVF clinic which respects your time and intelligence ?

Saturday, February 23, 2019

Are you fed up of being treated as a number in your IVF clinic?

Making sense of your IVF medicines

The superovulation protocol we use for IVF patients depends on two things.

One is the patient herself. For  example, what her ovarian reserve is , as judged by her age, antral follicle count, AMH level; and her historical response to previous IVF cycles.

The second variable is how many follicles we want you to grow. For example, if we want lots of follicles, we use a standard protocol, or an aggressive protocol, so we get lots of follicles . This allows us to collects lots of eggs, and this allows us to form many embryos , which we can then freeze and store.

On the other hand, if we don't want too many follicles ( for example, if we are worried about the risk of OHSS - ovarian hyperstimulation syndrome) , then we will use a minimal stimulation protocol so that we get only few eggs, and few embryos. Hopefully, these few ones will be the top quality ones.

This is a decision we make in partnership with our patients .

 If you understand your options, and can figure out what we're doing and why it, you'll be in a better position to be able to have an intelligent discussion with your doctor !

Find out more by downloading the IVF comic book free at
What to find an IVF clinic which respects your time and intelligence ?

Friday, February 22, 2019

No privacy in your IVF clinic?

Making sense of your IVF medications !

Many patients get confused by all the medicines and injections which are used in an IVF cycle, and this is partly because doctors themselves are very confused.
You need to step back and look at the big picture to make sense of the technical minutiae.
All we're trying do when we super-ovulate you is to help you to grow lots of mature eggs. We want you a synchronous cohort of follicles, all of which are roughly the same size.
In order to do this, we have to give you hormones  to stimulate your ovaries, which normally produce only one mature follicle ( which contains only one mature egg) every month. These could be by bumping up the level of your own endogenous hormones, by using Letrozole, which increases the FSH produced by your pituitary.
We can also give you hormones in the form of injections. These are the gonadotropin hormones - FSH and LH. These could be urinary gonadotropins, or pure recombinant FSH.
We adjust the dose, to get you to grow lots of follicles, and when the follicles are mature, we then trigger ovulation using HCG , so that we can then retrieve your eggs and send them to the embryologist in the IVF lab, where he can fertilise them.
Which particular protocol we use depends on various factors, including your age, your previous ovarian response, and how many follicles we want you to grow.
Along with the gonadotropins, we also use GnRH agonists or antagonists, to make sure your follicles do not rupture on their own !
You can learn more about IVF treatment by downloading  the IVF comic book free at

What to find an IVF clinic which respects your time and intelligence ?

Thursday, February 21, 2019

Which hormone injection works best in IVF ?

There's still a lot of confusion as to whether we should use urinary gonadotropins or recombinant gonadotropins in IVF for superovulation ( = helping patients grow lots of follicles).
Historically, we used urinary gonadotropins for many years. These are biological products , extracted from the urine of menopausal women , and they still work very well.
The problem is that there is a lot of batch to batch variation , because the quality of the extracted hormones is not always consistent, and this can create a lot of problems, because patients don't respond well to the superovulation. This is why it's so important for doctors to insist on seeing the bioassay report of every batch of urinary gonadotropins which they use for their patients.
This is why the newer advance is to use recombinant DNA technology to produce rec FSH in the lab in vitro. These are  much purer molecules, but the problem is they are more expensive , and this adds to the patient's financial burden .
This is why  it's important to use a judicious mix of the two.
Their efficacy as far as growing follicles is exactly the same, but some doctors worry because of the LH which urinary gonadotropins contain , because LH is considered to be a villain in IVF.  However, in clinical practice, it makes absolutely no difference to IVF outcomes at all.
Want to make sure you are getting the best possible IVF treatment ? You can download the IVF comic book free at
What to find an IVF clinic which respects your time and intelligence ?

Wednesday, February 20, 2019

Embryo pooling for patients with poor ovarian response

Lots of patients who have a poor ovarian response end up getting only one or two embryos in an IVF cycle . Their options are to transfer the fresh embryo in the IVF cycle; or to freeze them, one at a time , store  and pool them, and then transfer them later on, one at a time, after thawing them.

The reason this is a better option is because time is at a premium for patients with poor ovarian reserve. Transferring an embryo and then waiting to see whether a pregnancy occurs or not ends up consuming a lot of time. It makes more sense to do 3-4 egg collection cycles , back to back , and therefore collect lots of eggs , and as many embryos as possible , within a short span of time.

Once your embryos are frozen, you now have the luxury of time of being able to transfer these embryos back into your uterus whenever you're ready. You don't have to worry about the ticking of your biological clock damaging your chances of getting pregnant, because your embryos are safely frozen !

What to find an IVF clinic which respects your time and intelligence ?

Tuesday, February 19, 2019

Are you fed up of being treated as a number in your IVF clinic?

Does your IVF clinic seem to be an assembly line where they're more interested in extracting your money rather than treating you as a human being?
Do you feel that there's no overall treatment plan or continuity, and that every time you go to the clinic you meet a different doctor - usually an assistant or a junior - who has no idea what's happening?
Do you find that you have to wait for hours on end with no clarity at all?
Do you find that no one is willing to share medical records with you or give you any details as to how your treatment is progressing?
Do you find that there always seem to be last-minute changes in your treatment protocol based on some arbitrary reason , and no one gives you an answer as to what's happening?
Do you feel that after you've paid your money they only treat you as a wallet rather than as an infertile woman who wants to have a baby deeply?

If so, then please come to us for your treatment. We're a boutique IVF clinic where only Dr. Anjali and I take care of all our patients personally. We're very hands-on, experienced, expert and empathetic !
What to find an IVF clinic which respects your time and intelligence ?
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Monday, February 18, 2019

No privacy in your IVF clinic ?

IVF can be a very personal touchy, sensitive issue.
When you go to an IVF clinic, you expect your doctor to respect your privacy and talk to you one-on-one, because you want to share things which you're not comfortable sharing with other people.

Unfortunately in most IVF clinics, this privacy is sacrificed. There is a rush of patients , which means there are often two or three patients crowding around the doctor at the same time. Often, the consulting room door is wide open, which means other patients can hear the conversation you are having with the doctor, when he says thinks like, "Yes, you need to use donor sperm" or, "We should consider using donor eggs."

This is disrespectful of the patient's needs ! It's high time IVF doctors learnt to respect patients' needs - after all, they charge so much, and they can't just concentrate on maximising their income by trying to see as many patients as possible in a short time.

It's far more important for IVF doctors to make sure that patients feel cared for !

What to find an IVF clinic which respects your time and intelligence ?

Sunday, February 17, 2019

Which kind of IVF patients are we the best doctors for?

A single IVF clinic cannot possibly be right for all IVF patients . This means patients need to make a trade-off when selecting an IVF clinic !
Should they go to the cheapest ? the nearest ? the most well known one ? the one who advertises the most ? the one who holds free camps ? the one who their GP sends them to ?
I believe every doctor gets the patient they deserve, and every patient gets the doctor they deserve.
This is why it's very important that the patients who come to us are those who appreciate the unique value which we add to IVF treatment.
What makes us special is we have a lot of experience and expertise, and because we don't have any assistants, all the care we provide is very personalized, bespoke, and hands-on .
We focus on making sure that we maximize your chances of getting pregnant , by doing exactly what's right for you , because we use the latest technology and apply it intelligently to your needs.
This is why we are the best bet for patients who value doctors who respect them ! We want patients who are seeking doctors who have the time to talk to them, and who are transparent and open .
We take pride in treating challenging patients who have failed IVF cycles in other clinics !
What to find an IVF clinic which respects your time and intelligence ?

Clinic Mobile: 9867441589 

Friday, February 15, 2019

Making sense of IVF treatment

One of the problems with IVF treatment is that patients still don't understand what the process involves.  Not only doctors love complexifying the process ( so they can charge more for it !), there are so many myths and misconceptions floating around - both online and in the real world, that they don't know whom to trust.
Most of them assume that it's too complicated for them to understand, and are happy to leave everything upto their doctor. This is why they are very vulnerable, and it's easy for unscrupulous doctors to tale them for  ride, by using tons of jargon - and using this as a pretext to charge more for every additional service they offer - most of which are not needed at all. Sadly, patients can't push back, because they are so clueless about the process.
All you need to understand is that IVF is just the final common pathway which doctors can use in order to help you have a baby - it's a solution which allows us to bypass all the problems which can cause infertility. The good news is that that once you get pregnant after IVF, it's like any other pregnancy.
Think about it this way. Normally, the egg and the sperm fertilize and form an embryo in the fallopian tube , when fertile couples have sex in the bedroom. This embryos reaches the uterus after five days, and it then implants in the uterine lining.
Now, any problem in the bedroom - either with the sperms or the eggs or the tubes - can prevent this from happening, and cause infertility. In IVF, we fertilise the eggs with the sperm in the test tube, so that the embryo then spends 5 days in the test tube, instead of the fallopian tube ! After 5 days, we transfer the blastocyst back in the uterus, and if it implants, this is exactly like a normal pregnancy !
You can download the IVF comic book free at 

Thursday, February 14, 2019

What will my donor egg IVF baby look like?

One of the biggest concerns which patients who do donor egg IVF have is - What will my baby look like?
They have to take a major leap of faith, because they don't get a chance to see what the donor looks like. They major worry is - Will my baby resemble me , or will people know that I've used donor eggs? Will my baby be intelligent ? Will my baby behave the way I do?
It's normal to have lots of concerns, ICMR rules in India don't allow us to show photographs of egg donors, because egg donation in India has to be confidential and anonymous.
That's why we reassure patients, and tell them that by using frozen donor eggs, we can match physical traits. However, at the end of the day, it's impossible to predict what a child look like  - after all, biological siblings don't looks like each other either !
You can read more about our donor egg IVF program at !
However, at the end of the day , your child will pick up your behavior, your habits, your mannerisms, because you're bringing up your child. This is why siblings resemble each other - not because of their physical traits , but because they imitate their parents, and absorb  the way they talk, smile, and behave . After all, let's not forget that husbands and wives also start resembling each other after some years as well !

Thursday, February 07, 2019

When doctors cause infertility !

The biggest tragedy in reproductive medicine is when patients are made infertile as a result of the doctor's treatment !
This hurts , because when you go to a doctor , you want him to help you to have a baby . However, when instead of doing so , he actually makes you infertile by doing the wrong treatment, this just adds insult to injury and makes you bitter and angry !
A classic example is women who have a missed abortion .
The standard method in the past for treating this was by doing a D&C . Today, thanks to advances in medicine, it's possible to terminate this pregnancy medically , using medicines such as Mifegest and Misoprostol , which allows the uterus to naturally empty itself. This is far safer for the patient, because the problem with the D&C is that it can cause intrauterine adhesions ( Asherman syndrome) , which damage the uterine lining, and prevent the women from getting pregnant again in the future . 
Sadly, many doctors don't offer the medical treatment option to their patients. They continue scaring them and forcing them to do a D&C , because this is much more profitable for them . It's quick and easy surgery , and they can charge for doing it . Since they can't charge as much for prescribing drugs, , they push patients into going into the operation theatre , even though this is not in the patient's best interests.
Now well-informed patients know that there is a medical option available , but even for these patients, it's easy for doctors to bulldoze them into doing surgery by saying - Your baby is dead , and this poison can then spread into your body , which is why it's urgent that we remove the baby right now , and surgery is the fastest and quickest way of doing this, and just takes a few minutes !
They scare the patient by telling them that medical abortions are painful , and have a higher risk of complications. 
However, the reality is the complication risk is much higher with a D&C , as compared with the medical procedure .
When patients realise afterwards that they been made infertile because of an unnecessary surgical procedure , they are very bitter , and refuse to trust any doctor in the future !

Wednesday, February 06, 2019

Iatrogenic infertility

Being infertile is bad enough, but when the infertility is caused by an infertility specialist, this makes it much worse !

Sadly, we continue to see lots of patients, whose fertility has been damaged because of poor quality treatment.

Here is an example ( names withheld to protect the guilty !)

I have a very low amh of 1.16. I have undergone 3 cycles of IUI from Dr G, a gynecologist, none of which were successful. After that, I underwent laparoscopic  surgery by Dr H, an IVF specialist, for removal of endometriosis cyst. During the procedure , the doctor discovered I had a hydrosalpinx in both my fallopian tubes , so they clipped it . This means now I can't concieve naturally. After a month break after the laparoscopy , I did two cycles of IVF , but both have failed. I have spent almost Rs 10 lakhs and this is now a big stress for me. What should I do next ?

This poor patient has had poor quality treatment, even though she has gone to brand-name leading IVF specialists.

There has been a litany of errors in her treatment, and the tragedy is that this is a common story we see

For one thing, there was no need to do an operative laparoscopy for the endometriotic cyst. This is unnecessary surgery , which does not help improve IVF success rates at all. It actually reduces fertility , as normal ovarian tissue is also removed along with the cyst wall, thus reducing ovarian reserve, which is exactly what has happened in this case.

Secondly, lots of doctors seem to be very keen on clipping the tubes for patients who have a small hydrosalpinx which is detected incidentally during the laparoscopy. This is best left alone, and clipping the tubes doesn't help at all - but ensures that the patient will now always need IVF if she wants to have a baby !

Cysts can always get be aspirated ( punctured) under ultrasound guidance ; and small hydrosalpinges should be left alone. The trouble is that most doctors have a knee-jerk reflex of " treating " any abnormality they find, even if it does not help the patient at all !

What to find an IVF clinic which respects your time and intelligence ?

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

Monday, January 28, 2019

Simplifying IVF !

I have found that patients are intimidated by the concept of IVF, and think of it as being a very complex treatment. This is also partly because doctors love adding a lot of medical jargon such as ICSI, PGT, blastocyst transfer and vitrification to the treatment. Perhaps this is also because they can charge an arm and a leg for it, because  the more complex patients think the treatment is , the more they can charge for it! 

However, the basics of IVF are very simple ! All we are doing is helping to kick-start a pregnancy , so that we imitate in the test tube in the IVF lab what would normally happen in the bedroom in the fallopian tube for fertile couples for 5 days . Once we put the embryo back in the uterus , you then have a completely normal pregnancy !

Once you strip it down to the bare essentials, you will realise that IVF is a very straightforward treatment . Yes, it's true that you require an experienced expert clinic to achieve high success rates, but the basics are simple , so don't let a doctor confuse and bamboozle you !

What to find an IVF clinic which respects your time and intelligence ?

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

Wednesday, January 23, 2019

आईवीएफ से मेरे प्रेग्नेंट होने के क्या चांसेज हैं?

Does your IVF doctor respect you?

Most IVF clinics aren't very open or transparent about the IVF treatment which they offer to their patients. Doctors - and even their assistants - are often very patronizing , and most Indian doctors are still quite patriarchal . They believe they should decide for the patient what is right for them, which is why they don't discuss options or explain alternatives. They will often railroad the patient into doing IVF treatment, and will even hide details about how the treatment is progressing.
Some of them will even use donor gametes , without bothering to inform the patient !
Ideally, you want a doctor who will treat you like an intelligent adult , who's capable of making her own decisions.
At Malpani Clinic, we discuss the pros and cons of all your options and give you all the information you require so we can empower you to make the decision which is right for you.
Everyone has different preferences , and because infertility is such a personal and a private matter , these are not decisions that your doctor can make for you - you have to make them for yourself !
What to find an IVF clinic which respects your time and intelligence ?
Please send me your medical details by filling in the form at so that I can guide you !

Tuesday, January 22, 2019

How many IVF cycles should I do?

Every patient starts an IVF cycle with the hope that it's going to be their first and the last. After all, if they didn't think so in their heart of hearts, very few would have the courage to actually start the cycle , because this can really be an emotional roller coaster ride which can be hard to cope with.
When an IVF  cycle fails, your heart breaks and you often go to pieces, which is why it's a good idea to take a physical break and then reassess your situation. Are you happy that you don't have to go back to the clinic? That means your heart is signalling that you have had enough ! On the other hand, are you looking forward to going back? Are you so miserable sitting at home because you feel that if you don't do the IVF, you're not going to get pregnant? This means you should go back again !
This is a very personal decision, and no one else in the world can make it for you.
The good news is that doing a second IVF cycle is often easier , because you already understand the medical details , and now know there are no medical risks involved.
If you make your own decision, you will have peace of mind you did your best, and will have no regrets later on !
What to find an IVF clinic which respects your time and intelligence ?
Please send me your medical details by filling in the form at so that I can guide you !

Monday, January 21, 2019

The infertility camp scam

Corporate chains of IVF clinics need to generate a profit, and in order to do so they need to drum up business.
Rather than wait for infertile couples to come to them, they go out into the community in order to attract infertile couples to come to them !
The best way of doing this is by holding free medical camps, and this is why infertility camps have become extremely popular - especially in tier two and tier three cities, where new IVF clinics want to grab as much market share as possible.
They offer a free camp with a free consultation with an IVF specialist, but the purpose of the consultation is not really to help the infertile couples, but to generate business for themselves so they can make more money.
They do this is by doing lots of tests, which allows them to pick up " problems" , and then advising everyone who comes to them to do IVF - whether the patient actually needs IVF or not.
The tragedy is that a lot of these patients could get pregnant with much simpler treatment options, but because these are not as profitable for the IVF clinic, they don't discuss these alternative cheaper options with the patients, and push everyone into doing IVF !
Here's a dirty little business secret - the metric they use for measuring the success of their camps is how many new IVF cycles did this help them to perform that month !
What to find an IVF clinic which respects your time and intelligence ?
Please send me your medical details by filling in the form at so that I can guide you !

Sunday, January 20, 2019

Cross referrals between urologist and gynecologist for IUI treatment

Lots of patients with a low sperm count are seen by a gynecologist , who then advises them to do an IUI treatment because they don't have anything better to offer them.
However, because their sperm count is poor, they refer the patient to an andrologist/ urologist .
Many urologists are clueless about male infertility treatment , because they specialize in doing other things , such as removing prostates and treating kidney stones. This is why most of them aren't very interested in treating the infertile man, because they are primarily surgeons who like operating.  And honest urologists know there is little they can offer in the form of therapeutic options to the infertile man.
However, when a gynecologist refers a patient to them , they are forced to test and treat in order to live up to their image as being specialists ! This is why they focus on trying to improve the sperm count or sperm motility, and they do that by prescribing all kinds of drugs, or by doing varicocele surgery.  
However, all of this is completely pointless and wasteful, and doesn't really help the patient.
However, the poor guy gets bounced back like a ping-pong between gynecologist and urologist. Any time the sperm count improves ( because it varies all the time , and not because of the treatment), both the urologist and patient gets excited , and is sent back to the gynecologist for doing an IUI.
The gynecologist dutifully just keeps on doing IUI after IUI, but nothing works, because IUI is not the right treatment for the infertile man.
Finally, the poor patient gets fed up, and finds an IVF clinic, which can do IVF/ICSI  treatment for this - which is the only treatment which will work for men with a low sperm count.
What to find an IVF clinic which respects your time and intelligence ?
Please send me your medical details by filling in the form at so that I can guide you !

Saturday, January 19, 2019

The misdiagnosis of PCO

We see lots of patients who are misdiagnosed as having PCO (polycystic ovarian disease) , and this is partly because lots of sonographers aren't good at making the diagnosis properly.
When they see a few ovarian follicles on an ultrasound scan, they interpret these as being small cysts, and any time they see a few cysts in the ovaries, they say that the patient has PCO.
This is completely incorrect, because there are very strict criteria laid down for how to make a diagnosis of PCO on an ultrasound scan. The antral follicle count needs to be high; the ovaries need to be large; and the ovarian stroma needs to be increased. Unfortunately , while many gynecologists are aware of these criteria, many sonographers haven't learned these.
This is why lots of patients who just have a few isolated ovarian cysts are being misdiagnosed as PCO, when in fact what they actually have is poor ovarian reserve !
The incorrect diagnosis results in incorrect treatment , and results in their losing precious time. This actually ends up reducing their fertility even further, which is such a tragedy !
Make sure your doctor understands the importance of checking ovarian volume, ovarian stroma and antral follicle counts when doing an ultrasound scan.
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