Wednesday, November 24, 2021

Bleeding during an IVF cycle does not mean your cycle has failed !

 


Whenever IVF patients start bleeding , they start panicking , because they believe this sign means that their cycle has failed . The problem is that since there really is no reliable way finding out what is happening to the embryo after it has been transferred inside the uterus , patients are forced to rely on their symptoms and signs to try to imagine what is happening inside their body to their precious embryo.

The truth is that these signs can be very misleading , and bleeding does not mean that they cycle has failed. After all, an embryo is just a ball of cells, and this bleeding comes from the uterine lining and not from the embryo . Patients worry that this bleeding means that their embryos has been expelled, but the phenomenon of implantation bleeding is well described , and this occurs in successful IVF cycles during the 2 week waiting period , because the embryo burrows into the endometrial blood flow, to extract nutrition for itself.

 It’s normal for patients to panic when they see the blood because of the uncertainty . They pray that everything is fine , but their mind automatically assumes the worst. They want their doctor to reassure them that all is well, but no doctor can do this. Until you do the beta HCG blood test 12 days after the embryo transfer , that suspense is going to remain – both for you and for your doctor.

 Please don’t give up hope just because you start bleeding . This blood will look just like menstrual flow, because it comes from the same source – the endometrial blood vessels !

We advice patients to rest; and we double the dose of hormonal support (oestrogen and progesterone ), and this will often stop the bleeding.

 Bleeding can occur even after the HCG test is positive and you have confirmed you are pregnant.

Spotting and bleeding during pregnancy is quite common, and comes from the uterine wall.

This is not fetal blood, because the fetus during an early pregnancy is very small and doesn’t have its own circulatory system, which means is doesn’t have any RBCs ( red blood cells) .

The reason we worry is that we don’t want patients to become unduly anxious, which is why we advice them to rest when they start bleeding, but the truth is there is very little we can do to influence the final outcome .

Yes, this bleeding during pregnancy can be scary , but do remember that over 50% of patients who bleed during pregnancy will 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 !





Tuesday, November 23, 2021

Transferring one embryo at a time actually increases pregnancy rates



Transferring one embryo at a time actually increases pregnancy rates 

This is a great example of how IVF patients can have their cake and eat it too , because transferring only one embryo at a time ( also known as SET or single embryo transfer) minimizes the risk of a multiple pregnancy, while actually increasing the chances of getting pregnant !

Let me explain.

Patients and doctors often get confused because they intuitively know that if you transfer two embryos at a time, the pregnancy rate in that cycle is better than transferring just one
embryo . While this is true , that is very short sighted as well .

Let’s assume you have two top quality embryos. You have two options. You can transfer both of them at a time, in which case there are 3 possibilities. 

1. Neither of them implant , in which case you have no embryos left , and you need to start a fresh cycle over again , which is an expensive exercise , and full of uncertainty 

2. One possibility ( with the lowest probability) is that both implant , In which case you end up with twins . This sounds like a very good outcome, because all IVF patients dream about an “instant family” ! Yes, twins look very cute when they are toddlers, and dressing them up in the same clothes is fun, but the reality is that the risk of premature labour in a twin pregnancy is much higher than with a singleton . If you do end up with a preterm birth, both your babies will end up in the NICU – the Neonatal Intensive Care Unit, which means you will have to spend a lot of money, and this stay creates considerable anxiety and tension. What’s worse is that their future development is often compromised , because many premature babies have long-term sequelae as a result of spending time in the incubator . This is why it is much safer to have just a singleton pregnancy .

3. Only one embryo implants, but then this means you have been lucky ! Why take a risk by transferring two at a time , when you would have been much better off transferring one and freezing the second ! Even if you don’t get pregnant in the fresh cycle with that single embryo , you still you’re your second frozen embryo which you can transfer in the next cycle. Not only is the pregnancy rate with this frozen embryo as good as with a fresh transfer, the cost is much less.

This option allows you to have your cake and eat it too , so don’t listen to any doctor who pressurizes you to transfer more than one embryo just because they aren’t confidence about the quality of the embryos their lab creates, and they want to artificially bump up their pregnancy rates at your expense !

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 !




Monday, November 22, 2021

Why do IVF clinics continue doing Day 3 embryo transfers when they know the pregnancy rate is much better with transferring blastocysts ?



Why do IVF clinics continue doing Day 3 embryo transfers when they know the pregnancy rate is much better with transferring blastocysts ?

The commonest excuse IVF clinics trot out for doing Day 3 transfers for patients who have only a few eggs is that a bird in the hand is two in the bush !

They tell the patient that it’s much safer to put back the embryos on Day 3 because there is a risk that they won’t grow to Day 5 in the incubator. They scare them by saying that if they arrest in the lab, there won’t be any embryos left to transfer on Day 5, and that it’s better to be safe rather than sorry. They are willing to accept a lower pregnancy rate, just to give patients the satisfaction that at least they reached the stage of embryo transfer. This is quite meaningless, because the joy is short-lived when the embryo fails to implant.  After all, patients don’t want an embryo – they want a baby !

Unfortunately , patients are clueless and accept this reasoning , but this is completely flawed , because we know that the implantation rate of a blastocyst is far better than the implantation rate of a day 3 embryo , because if has so many more cells, and has grown and developed further.

No Day 3 embryo can become a baby until it becomes a blastocyst first . It’s best to allow the embryos to become blastocysts in the lab, where we can monitor their quality and identify which ones to transfer, rather than dump them all back in.

Of course, if the lab is bad, then it is true there is a high risk the embryo will arrest and not become a blastocyst, but then the chances of getting pregnant with  Day 3 embryos made in a bad lab is poor anyways ! Bad clinics try to compensate for this by transferring many embryos at a time, because they want to pass the buck for IVF failure onto the patient.

Bad clinics are very worried that if the embryo arrests then the patient will blame them, and they don’t want to take this risk, because they refuse to be honest with their patients.  If the clinic does do a transfer and the cycle fails, then can pass the buck on the patient and blame “bad luck” for the failure of the embryo to implant ! After all, implantation is a black box, and doctors can’t control what happens to embryos after they are transferred, but it’s clear that the chances of a Day 3 embryo implanting is much less than that of a Day 5 blastocyst implanting.

Good IVF clinics continue monitoring embryos in the lab, and sharing photos of their daily progress with their patients, so they know exactly what’s going on. Even if the embryo arrests, this gives us valuable information as to what we can do differently in the next cycle . The problem is that if we transfer on Day 3 and then it fails to implant, we don't know whether the problem was because the embryo wasn't good enough to become a blastocyst, or whether some other factor was responsible for the failure.

While not having a blastocyst to transfer causes major heart-break, at least we have learnt important information from the cycle, and can tweak the protocol in the next cycle.

Also, the patient doesn't have to go through the unnecessary suspense of the 2ww. False hope can be cruel, and causes far more heartache !

Some bad IVF clinics justify doing a Day 3 transfer by saying that the best place for a day 3 embryo is the uterus , rather than the test tube . This is a lie.

The best place for a Day 3 embryo is the fallopian tube , and not the uterus . An embryos does not reach the uterus until it becomes a blastocyst, which is why you should not allow your doctor to do an embryo transfer until your embryos become blastocysts in the lab.

Otherwise, you will end up reducing your chances of getting pregnant . Please be proactive and don't allow your doctor to take you for a ride to suit his convenience

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 !





Sunday, November 21, 2021

Infertility can be a blessing



Infertile couples think of infertility as possibly being the worst experience they have ever been through. Most still think of infertility as being a curse , and it's true that being infertile can be extremely stressful.

However, there are advantages to being infertile as well , and sometimes reframing your prospective will allow you  to make the best of a bad situation.

 So here are the three boons which infertility confers.

 1.    Being infertile changes you as a person. Some people become bitter, angry and unhappy, and stop believing in God because they think he has given them a raw deal. Marriages will also break up because of the stress of stress of infertility . However, this is just one side of the coin. Many marriages will become much stronger,  because if you can weather the storm of being infertile, nothing in the future will ever harm your marriage . Similarly, because you experience first-hand what it's like to want something badly and still not be able to get it , some infertile couples become kinder, more compassionate , and more empathetic , because their suffering transmutes them. Because you have suffered pain, you will be able to understand someone else's suffering better .

2.    Most infertile couples are young , and being infertile is the first time they are forced to come to terms with the fact that not everything is in your control . You learn a bit of humility , and are likely to become a little more spiritual . This can help to deal better with life's uncertainties , because you learn the hard way that not everything is in your control .

3.    Finally, the biggest bonus by far is that when you do have a baby, you are likely to be a far better parent than the average couple . You are going to spend so much more time , love and energy on your child that she is going have a head start as compared to anyone else's children .

Yes, I know it's hard being infertile, and you might think of this advice as meaningless preaching by an IVF doctor who doesn’t understand what infertile couples have to go through.

Trust me, I understand your pain, but it’s upto you to change your perspective , so you can transform that pain into a blessing.

Please remember the Serenity Prayer

God grant me the serenity to accept the things I cannot change;

The courage to change the things I can;

And the wisdom to know the difference.


 

How much does an IVF cycle cost ? [Video]

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Wednesday, November 17, 2021

Why biology is no longer destiny for Indian women? [Video]


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Sunday, November 14, 2021

Bed rest is bad for IVF patients. [Video]

 


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Saturday, November 13, 2021

Why IVF babies are at increased risk as compared to normal pregnancies? [Video]


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