What is the most effective treatment option for women who have recurrent miscarriages?

 Many patients come to us who've had recurrent, unexplained first-trimester miscarriages, and they want us to do surrogacy for them. Which makes a lot of sense, doesn't it? After all, she is getting pregnant, which means she doesn't have any fertility problems, but she is not capable of carrying the pregnancy, which means for some reason she is miscarrying. And if she is miscarrying, then doesn't that mean that there's a problem with the uterus, and isn't it also very logical that if you switch the uterus and use the surrogate, the surrogate would go on to have a healthy baby?  but actually, it's not true at all, and let me explain why. Most recurrent first-trimester miscarriage patients miscarry because there's a genetic problem in the embryo.

We all know that the commonest reason for a first-trimester miscarriage is a genetic problem, and this is nature's defense mechanism. Rather than give birth to an abnormal baby, you stop the pregnancy there. Now if that's the issue, then obviously changing the uterus is not going to help, which is why surrogacy is a complete waste for these women.

The problem is that the embryos that they're creating are genetically abnormal. Now part of the problem is that these genetic errors are random. We have no control over them. We can't predict them, we can't treat them, we can't prevent them, and that can be very frustrating. But one thing we do know is that these genetic problems in embryos are usually because of genetic problems in the egg, and these problems are much more common in older women because as their eggs become older, they accumulate a lot of genetic defects.

So, statistically, the chance of having a genetically abnormal embryo is much higher in an older woman. This is why the eggs in these women are okay enough for them to ovulate and even to get pregnant with or without IVF, which means they can continue forming an embryo up to maybe six weeks or eight weeks, but then after that, because of that genetic abnormality, the cells stop dividing and this embryo cannot grow.

As a result, they miscarry, which could either be because the ultrasound shows no beating heartbeat or because they start bleeding. Now the reason for the miscarriage, the underlying reason, the root cause is because of an abnormal embryo, because of an abnormal egg. Doing surrogacy is not going to help. What these women actually require is donor eggs I know this sounds completely counter-intuitive but that's the truth and the reason for that is because embryos are active. The uterus, which is the soil, is very passive. It's the embryo, which is the seed, and if you have a good quality embryo, it's going to implant and continue to a healthy pregnancy.

But if you have a poor-quality embryo that is good enough to implant but not good enough to give rise to a healthy pregnancy, these are the women who miscarry. And I know using donor eggs may seem very counter-intuitive for these women, but especially if they're older, this is actually the best treatment option because that way they can carry their pregnancy and go on to have a healthy baby.

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

Demand embryo photos from your IVF doctor | Embryo Photos

 Demanding something from a doctor is unusual because patients are meant to be docile and compliant. But the reality is that most IVF patients are completely clueless about IVF treatment, and, sadly, bad doctors exploit their ignorance. They contribute to it by refusing to share information with patients and keeping them in the dark. Most doctors will take a very patronizing attitude towards patients. They tell them that IVF is so complex that they won't be able to understand it, so there's no point in wasting the doctor's precious time by asking him questions or even doing an internet search.

Rather, a good patient should trust the doctor blindly and leave everything in their capable hands. This is fine if you happen to end up in a good IVF clinic, but the bitter truth is that the number of bad IVF clinics far outweighs the number of good IVF clinics.

And if you can't differentiate between a good clinic and a bad clinic, you could end up in serious trouble. The simple solution to this problem is to demand photos of your embryos and good IVF doctors are happy when you ask for them. because they are open and transparent and take pride in the quality of medical care that they provide.

They are happy to document this because, if they have made good quality embryos for you in their IVF lab, your confidence in them is going to increase. Also, this improves their professional reputation because, when you ask other doctors for a second opinion, they can confirm that the quality of medical care you received is good based on the photos of your embryos.

 Bad doctors, on the other hand, are in the business of hiding information because they don't have confidence in the competence of their IVF lab. They will often lie to patients and tell them that their embryos are A-grade or top quality, but without providing photographs to prove it.

This statement doesn't actually mean anything at all. This is why intelligent, well-informed patients always demand embryo photos, and the right time to demand photos is before you start your treatment by ensuring that the IVF clinic routinely provides photos to all their patients. This simple step will ensure that you don't get stuck in a bad IVF clinic and then regret your decision later on because you ended up wasting your time, money, and energy in a poor-quality clinic.

Need help in getting pregnant? We provide a second opinion on all infertility issues. Please send me your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.

Don't choose your IVF doctor without reading this blog | IVF treatment

The two most common cruel tricks IVF patients are subjected to by their IVF doctors. An IVF cycle is full of ups and downs and uncertainty and you never know what's going to happen next. You're happy that you're growing follicles well, but the eggs may not be enough, the eggs may not be mature, or they may not fertilize. And you're never really sure what's going to happen next, and all this uncertainty takes a toll, which is why there is a lot of emotional stress.

But there are two cruel things that bad IVF doctors do that actually make it much worse. The first is that they transfer dead embryos back into the uterus. You might wonder why they do that. I mean, the dead evil is obviously not going to plant and become a baby, so shouldn't they just be honest and tell the patient, "I'm sorry your embryos are dead or they didn't fertilize or they didn't leave, or whatever the truth is. But they don't.

They hide the truth from patients because they're scared that if they tell the patient the truth the patient will get angry and upset or will demand the money back, so they don't want to take any responsibility. For example, the fact that there was an infection in the IVF lab that killed all the embryos and they take advantage of the patient's ignorance and gullibility, because they don't provide any documentation or photos.

They call all the embryos grade a embryos, whatever that means. And because there are no photos, patients don't know whether those embryos were dead or not. And to add insult to injury, these same cruel doctors will then give an HCG injection after the transfer. As you know, a urine pregnancy test measures the presence of HCG in the urine and if it's positive, that means the patient is pregnant. Now, if the doctor gives you an HCG injection after the transfer, this HCG injection is going to go into the bloodstream, which means a beta-HCG blood test is going to be positive. I'm going to go in the urine, which means your urine pregnancy test is going to be positive and then you're on top of the world. You're so excited. What a great doctor on my IVF cycle.

 I'm finally pregnant. This was such great treatment. it's only when you repeat the blood test that you realize that it's not doubling, and that's when you finally realize, hopefully when you've done your own homework or got a second opinion, that you realize you were taken for a ride and the doctor was just cheating you.

The trouble is that once you've had one bad doctor who's cheated you, you're not going to trust any IVF doctor in the future, and this is such a shame, and that's why it's so important that patients demand some information even before starting the IVF cycle. This is a routine practice in good clinics and a global best practice. Make sure your doctor follows it too.

Need help? We provide a second opinion on all infertility issues. Please send me your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so we can better guide you.

Is multiple embryo transfer better or does it reduce pregnancy chances ?

Many IVF clinics routinely transfer two, three, or four embryos at a time to inflate their success rates. Often, patients push their doctor to transfer more embryos because they think that transferring more embryos will increase their chances of having a baby. Let me explain why.

While it's true that transferring two embryos in one cycle has a higher pregnancy rate than transferring a single embryo in that cycle, this is actually comparing apples and oranges. Let's suppose you have two top-quality blastocysts, if you transfer both and don't get pregnant, you need to start a fresh cycle, which is expensive and stressful.

On the other hand, if you transfer one and freeze the other, you can use the frozen embryo for your next attempt in case the first one fails, which is much less expensive, and if you do not get pregnant with the transfer of a single embryo, you can use your frozen embryo for your second baby.

This is why we tell patients that it's much more sensible and cost-effective to transfer only one embryo at a time because we are not wasting the spare embryos; we are freezing and storing them for you, and the success rate of freezing and thawing embryos is nearly 100% in a good clinic thanks to the science of vitrification. In fact, the embryo implantation rate is higher with frozen embryos because we can prepare the endometrium better, so that its receptivity is optimal.

Now if you transfer two embryos and both implants, you might think that this is a great outcome because you have created an instant family and got a bonus in the bargain: two babies for the price of one. This is actually not true because the complication rate with multiple pregnancies is much higher than with a singleton pregnancy.

The risk of miscarriage and the chances of pre-term labor are increased considerably, which means these pregnancies will often end up in a NICU or neonatal intensive care unit; they will often have lifelong problems because they were so small when they were born; and the biggest tragedy is that this is a hydrogenic problem, one created as a result of medical care by transferring more than one embryo at a time when you need to decide whether you should transfer two embryos at a time. With transferring a single embryo, you should compare the live birth rate, with two embryos at one time with a single embryo at a time in two consecutive cycles. The cumulative overall conception rate with transferring one embryo and freezing the other one is actually better because freezing embryos has become a standardized process.

 And the implantation rates are higher in a frozen cycle because it's possible for us to prepare the endometrium so it's optimally receptive. If your doctor insists on transferring more than one embryo, that is a red flag, because it suggests he doesn't have enough confidence in the quality of the embryos his IVF lab creates. The best way to check the quality of your embryo is to demand it by demanding photos of your embryos. This is standard clinical practice and something that all good clinics all over the world do routinely and proactively. Remember that more is not always better. Read our free IVF comic book at www.drmalpani.com.

Need help? We provide a second opinion on all infertility issues . Please send me your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so we can better guide you.

Is Surrogacy the right treatment option for recurrent pregnancy loss ?

Many women who've been unfortunate enough to have experienced recurrent pregnancy loss, recurrent miscarriages, or habitual abortion often believe that surrogacy is the right treatment for them. The logic is very clear and, in fact, a lot of doctors believe this too. The fact that they're getting pregnant means they don't have a fertility issue, which means the eggs are okay, the sperm is okay, and the tubes are okay. The embryo is implanted in the uterus, but the uterus is not able to hold on to that embryo.

It cannot sustain or support the pregnancy. This means if there's a problem with the uterus, it's just common sense to find another woman (it's called a surrogate) who's had a pregnancy in the past and whose uterus is normal. And if you then put that intended parent's embryo in this surrogate's uterus, that embryo will continue growing and they'll be able to have a healthy baby because she will have a healthy pregnancy. Actually, this reasoning is completely flawed, and let me explain why. It's like the soil. It's the seed or the embryo which is active.

It's the seed that actually does all the work. The uterus doesn't have to do anything at all. This is in fact, why older women who, let's say 60, even though she hadn't had a period for 20 years, were absolutely fine once you started treating her with hormones and she could carry a baby all the way to nine months. Now remember, if this woman can carry at the age of 72, she's not going to have a problem carrying at a younger age and that's exactly the point; the uterus does not have a biological clock.

The problem is that they are not able to carry the pregnancy because the embryo is genetically abnormal. It's difficult to diagnose a genetically abnormal embryo, but research has shown that the most common cause of a first-trimester miscarriage is a genetically abnormal embryo, and the most common reason for a genetically abnormal embryo is genetically abnormal eggs, which usually occur in older women because their eggs have aged and accumulated a lot of genetic defects that we can't diagnose, treat, prevent, or predict.

Now, Interestingly, because the uterus is passive, therefore, what they really need to do is not worry about changing the uterus. What they need to do is change the embryo. Again, this sounds very counter-intuitive, but it's the truth and the reason for this is that it's the embryo that determines the fate of the pregnancy at the end of the day. In fact, a woman who's had recurrent miscarriages most of the time has a completely healthy uterus. After all, if a uterus hadn't been healthy, the embryo wouldn't have been implanted in the first place.

The fact that the embryo is implanted means a uterus is working fine. This embryo can't continue to grow because it's genetically abnormal, which is why nature terminates that pregnancy at either eight weeks or ten weeks or what have you, and this is why these women do not need surrogacy. Because even if they did a surrogate with their own eggs and sperm, that surrogate would end up miscarrying again because the underlying problem is the genetically abnormal embryo. Because the genetically abnormal eggs are not going away, what these women require to have a healthy baby is donor eggs. which doesn't sound intuitive I get that, but that is the one treatment option that will maximize their chance of having a healthy baby because once they use a younger woman's eggs, those eggs are much more likely to be genetically normal as compared to using their own eggs, which have a much higher risk of being genetically abnormal because they are older.

Need help in getting pregnant? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.

Learn how to become a Smart Patient ?

Many patients who have had unsuccessful IVF cycles are shocked and confused by how little knowledge they actually have of the IVF procedure. Despite being extremely bright and educated professionals, they don't appear to understand how many follicles they developed, how many eggs the doctor gathered, how many embryos were transferred, or the quality of the embryos, despite all of this information being available to them.

This is partially a result of IVF experts' refusal to disclose information to their clients. They encourage their patients to basically leave everything up to them because they want them to be viewed as the expert, which keeps them on their toes. Since they are IVF experts and will perform the necessary tasks. Because it is much more convenient for them when patients obediently follow the doctor's recommendations, they treat their patients like idiots. In fact, these IVF doctors advise patients against using Google or other independent research methods.

IVF is described to patients as being incredibly complex and requiring ten years of training for a doctor to grasp, which makes it impossible for a patient to understand such a complex medical procedure. Because there is so much inaccurate information out there, many patients feel lost while trying to conduct a Google search to learn more about IVF. Furthermore, determining which information is trustworthy and which is not becomes difficult.

However, it is quite simple for dishonest doctors to take advantage of you if you don't know anything about IVF. IVF specialists know that infertile patients are hopeless and gullible, which makes it so simple to cheat them. But when it comes to IVF, you can't afford to be a dummy; you need to do your research. Both before beginning the IVF cycle and throughout the IVF procedure, in order to ask the proper questions and gather the necessary information regarding medical care. It's far too crucial to leave everything up to the doctor, and a smart doctor will really advise you to learn as much as you can on your own.

They want you to have realistic expectations of what you can accomplish for them because they are aware that you will be better knowledgeable about IVF.  The lesser will be your stress levels and the happier you will be with the quality of care they give you.,  On the other hand, if you are completely clueless about IVF you will not know whether the care has been good or bad. and if the IVF cycle fails because the doctor was bad you will deprive yourself of your best chance of having a baby. Knowledge is power and ignorance is not bliss, so please arm yourself with information therapy before starting an IVF cycle. You can do this for free at www.drmalpani.com

Need help in getting pregnant? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.

Best treatment for Recurrent Miscarriages | Pregnancy Loss

 It can be both extremely frustrating and quite satisfying to treat patients who have recurrent miscarriages. Recurrent pregnancy loss, recurrent miscarriages, or chronic abortion are terms used to describe people who have experienced two or more losses. It's disappointing because, despite conducting a full panel of tests on these individuals, we frequently come up with no results at all. The uterine cavity is normal, the chromosome studies are normal, and there are no signs of hormone imbalance.

The majority of these patients suffer from repeated first-semester miscarriages, which means that the miscarriage occurs at around eight to ten weeks and we are unable to identify the cause. It goes without saying that these patients are quite frustrated. Patients are now quite concerned about how the doctor will be able to treat them if he can't identify the underlying cause of the diagnosis, which is curiously why the entire course of treatment is not predicated on identifying a problem. Empirical therapy, which is founded on experience, is the foundation of the treatment.

 The good news is that studies have shown that even women who experienced three, four, or five recurrent miscarriages could eventually conceive successfully. If they don't give up and keep trying, more than 50% of them will eventually succeed in having a healthy kid with just one straightforward intervention. that's what tender loving care, or TLC, is all about. Now, this might seem incredible. After all, how could delicate loving care, especially for a woman who has lost, affect the result of pregnancy?


You could reasonably assume that because she's miscarried three times, the likelihood of her miscarrying a fourth time will be substantially higher, but this is untrue. and in fact, this is one of the main justifications for any treatment given to these individuals, be it immunotherapy, intravenous immunoglobulins, paternal lymphocyte vaccination, or anything else.

 




The reason why any therapy works so well, in my opinion, is that most of these patients don't need it. As a result, the baseline success rate for these women would remain at 50%, even if they undertook no additional interventions. which is fantastic because it means that half of them would go on to have a healthy baby and, guess what, they would attribute it entirely to the medical care, and the doctor would be more than happy to accept this credit as well.

Therefore, even though we frequently cannot identify the cause of miscarriages, there's no need to become discouraged. Despite the fact that you might feel like the odds are stacked against you, if you continue to be patient, your chances of having a healthy kid are very strong. Therefore, please hold onto hope.

Need help? We provide a second opinion on all infertility issues. Please send me your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so we can better guide you.