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 !

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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



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