Wednesday, January 16, 2019

What is your IVF commission rate?



Gynecologists refer infertile patients for IVF treatment to specialist IVF clinics ,because they can not offer this treatment themselves.
One would logically expect them to send their patients to the IVF clinic with the best pregnancy rate because they want all their patients to get pregnant.
This is why you would expect that when gynecologists meet IVF specialists, the question they would ask is, "What's your success rate?" or "How do you tackle with patients with a particular complex problem?"
But interestingly, the commonest question gynecologists ask IVF doctors these days is, "What is your commission rate?" which means, "How much money will you give me for referring a patient to you?"
The tragedy is that because kickbacks have corrupted the medical profession, IVF patients are no longer being sent to the best IVF clinics by their gynecologists, but they are being referred to the clinics which provide the highest kickback to referring doctors, even if their success rate is poor.
The new corporate chains of IVF clinics have made a bad situation worse, and this is now becoming a race to the bottom, so that IVF clinics are no longer competing on the basis of their success rates, but on the commission rate they offer !
What a tragedy !
You can learn more about IVF by reading the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
I am also happy to provide a free second opinion at www.drmalpani.com/free-second-opinionhttp://www.drmalpani.com/free-second-opinion !






Tuesday, January 15, 2019

When Freezing Embryos is a Bad Idea.



In the past, the pregnancy rate with frozen embryos was poor, because a lot of these embryos would die as a result of the freezing and thawing process. The standard method was called slow freezing, and when the embryos were thawed, the ice crystals in the cytoplasm would kill the embryos. However, today, with flash freezing or vitrification, the survival rate is 100% in good clinics.
However, the reality is that not all clinics are good clinics , and lots of them don't have the experience or the expertise to be able to vitrify embryos well. As a result of this, a lot of these frozen embryos get damaged during the thaw process.
The trouble is that these labs don't share the truth with patients. They don't give them photos, so patients have no idea that the doctor is transferring damaged or dead embryos into them - embryos which have a 0% chance of implanting. Some labs do provide photos, but they doctor them , and patients aren't sophisticated enough to realize that the cells are dead or damaged.
This is why so many of IVF patients start believing that freezing embryos just doesn't work .
However, it does not work because the labs are bad - there's nothing wrong with the freezing technique !
That's why it's so important that you demand the clinic give you photos of your embryos, and that you do enough homework so you can make sense of them. No , you do not need to become an embryologist, but being a well-informed patient will help you get the best medical care from your IVF clinic, and maximise your chances of getting pregnant !
What to find an IVF clinic which respects your time and intelligence ?

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, January 14, 2019

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



We treat IVF patients who come from different backgrounds , and it's interesting to see that the ones who are engineers and MBAs want to use the latest advanced technology in order to solve their problems . These are the patients who want us to do all kinds of tests, such as  ERA ( endometrial receptivity assay) , PGT ( preimplantation genetic testing) and sperm DNA fragmentation, because they've read about these newest tests on Dr Google. 
They believe that the more the technology we use, the better their chances of getting pregnant with IVF. They know that IVF success rates are not 100%, and their belief is that the deeper we investigate problems using sophisticated technology ( for example, genetics and immunology), the higher their chances of success with IVF will be.
This is a very tempting conclusion to come to. After all, if more technology helps to improve smartphone performance, it's it logical that more technology will also help in the IVF lab ?
Unfortunately , the overuse of technology in medicine often backfires , and ends up causing over-treatment, which actually reduces pregnancy rates . Biology is messy because it's  a complex adaptive system . You may do an intervention in good faith , based on sound logic that this will increase chances, but this often end up having second order unintended consequences which end up reducing pregnancy rates !
A great example is PGT, which is being oversold as "precision IVF", so please be careful before being lured down this path !
What to find an IVF clinic which respects your time and intelligence ?
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, January 13, 2019

What IVF patients need to do when they are not sure what to do !



We treat many challenging patients, and because their treatment is complex , they are often unsure what to do next. For example, they have failed 2 IVF cycles elsewhere, and have grown only 3 follicles in the current cycle, even though we have superovulated them aggressively.
They are not sure whether they should cancel the cycle , or whether they should continue because they know that we may or may not get an egg; the egg may or may not be mature; it may or may not fertilize; and it may or may not form a good quality blastocyst.
If they go ahead, they will end up spending a lot of money , and if they don't get to the stage of embryo transfer, this can cause major heart burn.
They want the doctor to decide, and because we are IVF specialists , they expect us to tell them what to do.
The problem is that we can't predict what the outcome is going to be ! We can tell them what the right process is , and offer high quality care technically, but we're not fortune tellers. If we tell them in good faith to go ahead and we don't get any eggs , the patient may feel cheated - she may feel that we did the procedure just in order to earn money, whereas the reason we did it was to give her the best possible shot at getting pregnant  - after all, there is no certainty that she will grow even 1 follicle if we try again.
This is the process we use to counsel our patients. We tell them - As professionals , we will not allow you to make a decision which is medically wrong, but when there are choices , we will help you to make the decision which is right for you. However,  you do need to listen to your heart to find out what this is !
What to find an IVF clinic which respects your time and intelligence ?
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, January 12, 2019

The three things you need to bring to an IVF cycle.


When patients come to us for an IVF treatment , we request them to bring three things with them - and no, money is not one of them !
First is lots of follicles, because obviously the more the follicles you have, the more the eggs, and the better your chances of getting pregnant. Now I understand that patients can't control how many follicles they will grow,  because this is a biological variable, but it's a good idea to visualise that lots of them are growing !
Second is  lots of smiles, because being optimistic and hopeful helps ! IVF treatment is thought of as being stressful, but it should actually be a stress buster. You should look forward to doing your IVF treatment because it maximizes your chance of getting pregnant - after all, not having a baby is very stressful, and IVF should help to reduce this ! If you're optimistic, we think it just makes going the cycle that much easier , because IVF should be a positive process.
Third, bring realistic expectations. Please do your homework , so you understand what's in your hands; what's in the doctor's control;  and finally what's in God's hands, so you have peace of mind you did your best.
What to find an IVF clinic which respects your time and intelligence ?

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, January 11, 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 to you ?
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 your 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 find that the senior doctor is always inaccessible ?
Do you find that there's a huge rush, so the doctor doesn't have enough time to spend answering your questions ?
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?
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, and have lots of experience and expertise to treat you with tender loving care, which is why we have such a high success rate !
What to find an IVF clinic which respects your time and intelligence ?
Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Thursday, January 10, 2019

Making difficult decisions - a guide for IVF couples



While most IVF cycles are straight-forward, sometimes we come to a cross-roads when it's not always clear what the next step should be .
For example, if have poor ovarian reserve, and have grown only 2 follicles after aggressive superovulation, should you cancel the cycle? Or should you continue?
These decisions can be difficult to make, and it's especially when patients find they have to make a difficult decision that they expect their doctors to tell them what to do. After all, doctors are professional experts, and they have the experience and the skills to decide. How can a patient decide for herself ? She has never done this before, and is confused, and wants her doctor to decide on her behalf.
                                It's very easy for a doctor to be paternalistic and tell you what to do, but I don't think this is a good idea . After all, even if the doctor's intention might be honest, if he tells you to go ahead and then fails to retrieve eggs, the patient is likely to feel cheated. She may feel that the doctor did it only to earn more money - and may resent the doctor for subjecting her to a futile procedure. After all, patients need to live with the consequences of the decision. We don't want them to feel afterwards - "I wish I'd done this," or, "I wish  hadn't done that."
A respectful doctor will explain the facts to the patient , and try to respect the patient's personal  preferences. We will  empower the patient to make a decision which is right for them.
The secret is to follow the path of least regret. Thus , if you choose to cancel the cycle, will you kick yourself afterwards that you didn't give yourself the best chance of getting pregnant with your own eggs? Then please go ahead and do the cycle  - and even if the doctor doesn't collect any eggs, you will have peace of mind that you have followed the best process - and this is all anyone can do !
What to find an IVF clinic which respects your time and intelligence ?

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, January 09, 2019

The IVF doctor's dilemma



As an IVF doctor, I try to be non-directive in my counseling , and help patients to make their own decisions for themselves. It's easy to be judgmental and patriarchal , but we want our patients to feel that they have the ability to make their own decisions , and we want to respect their preferences.
Therefore, we explain all their choices to them , and tell them that they should make a decision which feels right for them. After all, IVF treatment is elective, and patients have many options.
Sadly, this backfires, because lots of Indian patients aren't very happy with this approach . They want a doctor who will decide for them - after all, isn't the doctor the expert ? And aren't they paying his fat fees for his advice ? Isn't it his job to tell them what to do ? What kind of doctor asks a patient for their opinion ? Doesn't he know what the right decision is ?
While it can be very tempting to decide on behalf of the patient , this is not in the patient's long term best interests. If you blindly agree with what the doctor tells you today , you may regret this afterwards. You may wonder why you allowed the doctor to decide something which was so critically important - and the problem is that doctors can't be mind readers, and don't know what your personal preferences are .
Use a doctor as a valuable sounding board and as a trust source of medical information , but please make the decision for yourself.
You can get a free second opinion by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Tuesday, January 08, 2019

Busy IVF clinics vs efficient IVF clinics !




Going through an IVF treatment is stressful, and we try to reduce the stress of our IVF patients by managing their medical treatment remotely as far as possible , so they have to make fewer trips to the clinic .

Thus, for out of Mumbai patients, we encourage them to do their tests locally; we share the treatment plan by email ; and answer questions by email and WhatsApp. This way, they can start the treatment directly, instead of having to come to Mumbai first for a consultation, and then to come back again for their actual treatment.

We encourage our patients to take their injections by themselves , which means they need to the come to the clinic only 4 - 6  times during their treatment cycle . This means that there aren't too many patients present physically in the clinic at any time, which is good for patients , because they don't need to wait to see us.

On the other hand , this efficiency sometimes backfires , because patients get the impression that we don't do many IVF cycles , and aren't very busy .

Other IVF doctors seem to take pleasure in calling patients to the clinic treatment every single day - either for scans, blood tests or injections - whether they actually need this medically or not !

Because the clinic is then overflowing ( with waiting patients and their family members), this gives the impression that they must be very good, because they attract lots of patients.
Patients are naive, and believe that busy doctors are good doctors, because there are so many patients waiting to see him, and they are happy to follow the crowd.

We prefer managing patients remotely, this reducing their stress levels, their wait times, their commutes and their travel expenses !

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

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 !






आईवीएफ़/IVF के मरीज़ों को अपने फ़ैसले खुद क्यों लेने पड़ते हैं?

Sunday, January 06, 2019

डोनर एग का फैसला

Why are you better than other IVF clinics?




When patients have failed in IVF cycle at another clinic they lose confidence in all doctors .

They are naturally quite reluctant to try a cycle in another clinic, because the implicit question they're asking is, "What makes you better? Why will the outcome be better in your clinic as compared to the earlier clinic ?
After all, that IVF doctor was also a specialist, and they had a great looking clinic, with a very attractive website. At the time of the consultation, they claimed a high success rate, but the cycle failed , so why will you be any different?"                  
This is always a hard question to answer , because obviously every doctor thinks they're the best ! And after all, IVF treatment is pretty standard all across the world !

I think what makes us different is we are a boutique clinic. There are only two doctors, Dr. Anjali and me, and we take care of all our patients. We don't employ any assistants or junior doctors, which means all our care if very hands-on.
Also, we don't do anything else other than IVF , which means we are laser focused on getting you pregnant ! We want you to refer your friends to us !
Our experience and expertise ensures that we take great care of all our patients, and have a high success rate .
Ultimately every batsman plays with the same bat, but Virat Kohli's batting style is what makes him better - but this difference is intangible !
You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
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, January 05, 2019

ज़्यादा उम्र के मरीज़ और IVF

Have you failed a donor egg IVF cycle?



Patients do donor egg IVF with a lot of hopes , because they know that using healthy eggs from a young egg donor maximises their chances of getting pregnant - provided they receive lots of eggs , so they can transfer top quality blastocysts.
Unfortunately lots of IVF clinics in India aren't able to do a good job with doing donor egg IVF treatment.
For one thing, finding good egg donors is very difficult . Secondly, because they do not have the ability to freeze these donor eggs, they are forced to super ovulate egg donors and use fresh eggs for their donor egg IVF cycles.
The problem is that it's very hard to synchronize the recipient's cycle with that of the egg donor , as a result of which these patients often end up getting few eggs , so that the entire purpose of using donor egg is defeated, because they end up with poor quality embryos.
Because donors are at a premium, they are forced to share these eggs with other patients , as a result of which each patient gets very few eggs and embryos.
This is especially true when "diva donors" from overseas are superovulated for these patients. Sadly, beggars can't be choosers, and patients are forced to accept what they are given - especially since they have paid the fees in advance !
What compounds the problem is the complete lack of transparency, and patients are not provided any details about their embryos. They are just told that everything is fine - which means that nothing is fine !
If you have failed a donor egg IVF cycle in another clinic, please come to us , because we use frozen donor eggs and guarantee at least 10 mature eggs for each patient !
Read more about our donor egg IVF program athttp://donoreggs.in



Friday, January 04, 2019

Why are pregnancy rates with donor egg IVF so low in India?



Older women with poor ovarian reserve are often told to use donor eggs, because getting eggs from a young, healthy, fertile egg donor will increase their chances of getting pregnant.
This makes sense - provided they get a sufficient number of good quality eggs from the egg donor.
But the trouble is that most Indian IVF clinics don't have good donor egg programs. They super ovulate fresh egg donors, and then end up splitting these precious eggs amongst lots of recipients, whom they put on a waiting list.
This often means that they cannot synchronize the egg collection of the donor with the endometrial  receptive of the recipient, which is why a lot of these cycles fail.
Then these patients are pushed into doing surrogacy, because they're told, "If you can't get pregnant with your own eggs, and with donor eggs, then your only choice is surrogacy."
This is really tragic, because these patients are getting a raw deal !
What they need to do is to go a good IVF clinic, which uses frozen eggs , and can guarantee them that they will receive at least 10 top quality frozen eggs for their treatment.
The pregnancy rate with frozen eggs is better than with fresh eggs, because we don't have to worry about synchronising cycles - we thaw the frozen donor eggs only when the recipient's endometrium is ready.
Also, when we thaw these eggs, the survival rate is 100%, which means these frozen eggs turn into top quality fresh blastocysts, with a high implantation rate !
You can read more about our donor egg program at http://donoreggs.in

Thursday, January 03, 2019

The donor egg farce in India



For older women with poor ovarian reserve, donor egg IVF is a great option, because it increases their chance of getting pregnant considerably.
The problem is that it's hard to find good quality egg donors - and because response to superovulation is an unpredictable biological variable, often the number of eggs the clinic is able to collect from an egg donor is uncertain.
Tragically, lots of clinics continue to use eggs from a fresh egg donor , and this means that often the egg donor doesn't grow many eggs in the treatment cycle, or they're not able to synchronize the cycles of the donor and recipient properly.
This means they up getting only a few eggs from the egg donor; or the timing of the egg collection is not matched properly with the recipient's endometrial receptivity.
However, because the clinic  has lots of patients, and they don't want to maximise their income, they end up splitting the eggs between lots of recipients ! This is especially true when they fly down "diva donors" from overseas for their patients.
As a result of this, each patient gets allotted only a few eggs, which means she gets only a few poor quality embryos, and the entire purpose of using donor eggs is lost .
These patients not only end up failing fresh IVF cycles with their own eggs, they end up failing these fresh donor egg IVF cycles as well !
The clinic they advises them to do surrogacy - not because they need it , but because the IVF clinic is doing a shoddy job. The irony is that the clinic now earns even more money in the process ! What a tragic farce this has become today.
We have an active donor egg IVF program where we guarantee that we can offer you at least 10 mature high quality donor eggs from a high quality fertile donor, because we use only frozen eggs, which has now become the international standard practice. Read more at http://www.donoreggs.in/







Wednesday, January 02, 2019

The PCO misdiagnosis epidemic.



There seems to be an epidemic of PCO ( polycystic ovarian disease) today, but I think this is a myth.
This is because making the diagnosis has become so easy today - all you need to do is order a "PCO panel of blood tests" from a medical lab. In fact, lots of online portals will allow you to self-diagnose yourself, and order the tests yourself ( through their portal of course, where their preferred partners are happy to give them a kickback for the tests).
Also, these labs spend so much money on "creating awareness" about this "disease", that every second teenager has started believing she has PCOD ! Have a little bit of acne ? Oh - then make sure you don't have PCO ! Put on a little bit of weight ? You may have PCO ! Find a few extra hair on your face ? Make sure you dont have PCO !
This is why there is so much overdiagnosis and over-testing .
Now PCO is not a new disease - it's just that we're able to apply the diagnostic label with much more ease !
Thus, it's very common for hairdressers and beauticians to tell a client who has a little extra hair or some acne or oily skin that they may have PCO, and they need to test for it !
They are then happy to "refer" the customer to a friendly skin specialists, who is happy to order the tests. There is a high probability that the test results will come back as abnormal, and once a diagnostic label of PCO has been stuck onto a patient, it remains for life !
This is the real tragedy , because it's not really helping anyone - and it just ends up creating  more anxiety when they read about PCO on Dr Google !
You can read more about how we treat PCOD at 




Tuesday, January 01, 2019

The IVF Checklist



IVF can seem to be a demanding and complex treatment, which is why it helps if you are  well    organised !

1. Make sure you have completed all your tests

Wife
□ Ovarian reserve testing ( AMH, prolactin, TSH, antral follicle count)
□ Infectious disease screen: HIV, Hepatitis, RPR , Rubella
□ Vaginal ultrasound scan
Husband
□ Semen analysis
Infectious disease screen: HIV, Hepatitis, RPR/VDRL

Please note how short this list is !

Don't waste your money on useless and unnecessary tests such as sperm DNA fragmentation, TB testing, ERA, genetic testing or hysteroscopy !

2. Make sure you know how much you have to pay and when - financial surprises can be a rude shock.

3. Start taking your supplements ( such as folic acid, Vit D and DHEA, if prescribed). You might also want to explore yoga, meditation and acupuncture, to help you be ready for the IVF cycle

4. Make sure you have all the medications you  need for the treatment cycle.  Please don't waste for the last minute to order them !

5. Organise your logistics ( leave from work if needed; tickets for travel; and your husband's work schedule). You can print out your IVF treatment calendar at https://www.ivfindia.com/public/ivfcalendar.php if you are using the short downregulation protocol.

6. Re-read the IVF comic book at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf, so you know exactly what's going to happen during your treatment!

You can also 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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