What to do if you are stuck with a bad IVF doctor

 

Most patients are very naïve when selecting an IVF clinic, because they believe that all IVF clinics are equally good. They will sign up for IVF treatment at the nearest clinic , or at a clinic to which they have been referred by their family doctor , or perhaps to a clinic they have read about in an ad .

However, after they start their treatment , they realise that they are receiving very poor quality care . After they have paid their fees, they don’t get to see the brand-name doctor, and their treatment is handled by clueless juniors and disinterested assistants.

They have no idea as to how their cycle is progressing , and the clinic refuses to share basic medical information ( such as the number of follicles on the ultrasound scan, and their sizes). They refuse to provide photographs of the transferred embryos , so when the cycle fails, the poor patient has no idea what the real reason for the failure is .

The doctor then starts Operation Coverup ! He hides all the information, and then pushes the patient into doing even more tests, or suggesting more expensive treatment , by blaming the patient’s eggs, sperm, or uterus for the failure , when in fact the real reason for the failure was the fact that the doctor was incompetent , which is why the embryos were of poor quality.

Patients are smart , and they suspect the doctor is hiding information from them , and not being honest, but they don't know what to do when they are stuck with a bad doctor. This is partly because they have already spent so much money , that they are very reluctant to walk away – especially when the clinic has signed them up for a 3-cycle package by offering them a discount for this !

They are scared to take the time and trouble to find a new doctor , because they can't really be certain that the new doctor will be any better than the old one , and they are scared they will end up jumping from the frying pan into the fire. Another fear is that the new doctor will make them repeat all the tests all over again , meaning they will end up wasting even more time and money.

The one thing you should remember is that if you are stuck with a bad doctor , then continuing with him will only lead to more grief , and will just make a bad situation worse. There's no point in regretting what you have done in the past , because this is a sunk cost and you can't undo it, but you can definitely learn from your mistakes , so you can choose a better doctor the next time around !

Your first step is to get a copy of all your medical records , including photos of your embryos. If the clinic refuses to share this , please remember that your medical records are your property , and doctors cannot refuse to give them to you ! If they do, send them a legal notice please !

After you have obtained your records, the next step is to get a second opinion , so that you can determine the lacunae in your treatment ,  and can move on to a better clinic . The good news is that your ability to find a better clinic will now increase dramatically because of all the mistakes which you made in your first IVF cycle ! 

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 !

What to do when the doctor isn't able to collect any eggs

 

One of the reasons IVF cycles fail is because doctors tell patients that they weren’t able to collect any eggs during the egg retrieval . This can come as a rude shock, because patients expect doctors to be able to collect one egg from each follicle , and it’s very hard to understand why they weren’t able to retrieve any eggs at all .

When doctors don’t get any eggs, they commonly lie to the patient, and tell them they suffer from the rare condition called empty follicle syndrome ! This is not true, because empty follicle syndrome is a very specific condition which can be diagnosed only by doing special tests, but doctors don’t bother to do this , and will use this diagnostic label as a pretext to cover up their own incompetence, which is what really caused them to fail to collect any eggs.

Let’s look at the real reasons why some doctors aren’t able to find any eggs at the time of egg retrieval. One of the commonest reasons is that the follicles have already ruptured before the start of the egg collection . This is not uncommon, especially in large clinics that do many egg collections in a day , because they "batch" their patients together into one group. If the doctor waits for longer than 38 hours after the HCG trigger , the follicles will rupture, and the eggs will be lost in the peritoneal fluid. However, the doctor will refuse to take any responsibility for this negligence, and will hide the truth so that patients remain completely in the dark.

Another reason why the doctor may not be able to collect any eggs is that the doctor may not be technically competent . This is becoming increasingly common in IVF corporate clinics that run large chains , because they are happy to hire any doctor they can find , no matter how inexperienced or clumsy he may be. This is because their focus is not on providing a high quality clinic service , but on doing as many IVF cycles as possible , to maximise their profits. Many of these junior doctors don't have the experience or the expertise to collect eggs for challenging patients—especially when there are only a few follicles ( in patients with poor ovarian reserve), or when the ovary is hard to reach because of adhesions. The doctor blames the poor ovarian function, and then uses this as an excuse to tell the patient to use donor eggs for the next cycle.

Another problem could be a bad embryologist , so if he is not experienced enough , he may fail to identify the oocyte cumulus complexes in the follicular fluid that the doctor sends at the time of egg retrieval. He will claim that no eggs were found, and the hapless patient will never get to know the truth , because it's concealed , and no one is willing to take responsibility for the mess.

Finally , another reason could be equipment malfunction , so if the lab is not well equipped , or if there is a loss of electrical power, the suction pump used for the egg collection will not create the negative pressure needed, or the stereozoom microscope used in the IVF lab will stop working.

The result of this sad saga is that the poor patient will waste all their time , money, and energy - and to add insult to injury, the doctor will lie and tell the patient that there was a problem with her eggs, and she will need to use donor eggs in her next treatment cycle, which is a complete lie.

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 !

Embryo transfer versus embryo implantation

 

One of the problems that plagues IVF today is that most IVF patients are still very poorly informed about the medical details of an IVF treatment cycle . Patients justify their ignorance by saying that they don’t need to worry about the technical minutiae , because that is the job of the doctor ; they don’t understand the medical jargon, and that a little knowledge can be dangerous !

If you do go to a good doctor who takes the time and trouble to explain the details to you, and is transparent and accountable , you will be fine . But what happens if you don't go to a good doctor ? Or if your doctor is not willing to be open and transparent about your treatment, and who hides critical medical  information from you, because they know they are incompetent ? This is the kind of doctor who will take you for a ride , because you don't know enough to be able to protect yourself – and sadly, this is still the majority in India today.

This is why it’s so important that you invest in Information Therapy ! A good doctor appreciates patients who have taken the time and trouble to educate and inform themselves,  because they have realistic expectations of IVF treatment, and this makes life much easier for both the patient and the doctor , because they are on the same page .

The patient knows exactly what to expect, and can check if the doctor is doing this, because they understand what to expect. This also reduces their stress levels because they are less anxious, since they know what’s going to happen next.

On the other hand, bad doctors get very upset when a patient is well informed because they know they are not going to be able to cheat this patient . They often get angry with the patient who asks them questions, and will insult them by telling them that there is no point in their becoming a half-doctor !

You need to protect yourself , because you can't automatically assume that every doctor you go to is a good doctor . This is why you need to understand the difference between embryo transfer and embryo implantation . Embryo transfer is a simple clinical procedure that we do routinely. This is done under ultrasound guidance, and good clinics will always provide photographs of embryos , so that patients know that the treatment has been done well . Until the point of embryo transfer , the medical treatment is in our hands , but after we transfer the embryo into the uterus , whether that embryo will implant and become a baby is not something which anyone can control , because this is a biological process , and human reproduction is not very efficient . This is true , whether you are trying to make babies in your bedroom or whether you are doing IVF  - and this is why every fertile couple doesn’t get pregnant every month they have sex !

We have no control over the implantation process – it’s still a black box for us. This is why patients need to understand the difference between embryo transfer and embryo implantation, and this knowledge is extremely important , because you can then decide what to do next in case the first IVF cycle fails !

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 !

The difference between menstrual periods , ovulation and fertility

You have learned in your high school biology classes ( hopefully you were paying attention !) that a fertile woman ovulates regularly, which is why she has regular menstrual cycles, and that the central key event in the menstrual cycle is ovulation – the release of a mature egg from a ripe ovarian follicle, which normally occurs once a month.

If your cycles are irregular , this suggests that you are not ovulating.

This is called anovulation, and you can read more about this at  www.drmalpani.com/knowledge-center/articles/anovulation

 A common reason for this is PCOD ( polycystic ovarian disease) and you can read more at http://www.drmalpani.com/knowledge-center/the-infertile-woman/how-to-manage-your-pcod

Another possible cause could be poor ovarian reserve  and you can read more about this at http://www.drmalpani.com/knowledge-center/the-infertile-woman/oopause

However, you should also remember that just because your cycles are regular does not mean that you are ovulating . For example, some women have LUF, or luteinized unruptured follicle syndrome, where the follicle matures, but the egg remains trapped inside the follicle because it does not rupture.

Also, just because your cycles are regular does not mean that you can assume that your fertility is normal either. As you get older, your ovarian reserve declines, which means the quality of your eggs may be good enough for you to get regular periods, but this does not mean the quality of eggs is good enough for you to be able to have a baby.

The biggest problem, of course, is that you cannot see your ovulation , and all you can see is your menstrual period . This is why women often worry about the quality of their menstrual flow - whether it's black or red ; painful; scanty or heavy; and has clots. However, there is very little correlation between the quality of your menstrual discharge , ovulation, and fertility , so please don't get misled by this.

One of the biggest problems is that there is very little education about human reproduction , as a result of which most women remain completely clueless about the relationship between fertility , ovulation and the menstrual cycle . This is why you need to invest in Information Therapy , so you understand the differences,  and don't end up jumping to the wrong conclusions.

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 !

How to identify a bad IVF clinic

Many patients can’t travel to Mumbai to take treatment in our clinic, which is why a common question they ask me is – how do we identify a good IVF clinic? After all, the better the IVF clinic you choose , the better your chances are of getting pregnant !

The trouble is all IVF doctors are very friendly when you visit them for the first time. They are happy to promise you a baby , and they all claim to have the highest success rates when you go for a consultation. You only learn how incompetent they are after your cycle has failed, because they refuse to provide you with any information.

Here’s a solution to protect yourself from being taken for a ride. Use the following simple tool to identify a bad clinic – and by rejecting all the bad clinics, you will finally identify a good clinic !

Part of the problem is that patients can be quite naïve and immature , and they believe that all IVF clinics are equally good . The other problem is that patients don't feel they are qualified enough to be able to differentiate between a good IVF clinic and a bad IVF clinic . After all, they are just patients , whereas the doctor is the medical expert . How can they challenge his authority ?

The good news is that you only need the clinic to answer 2 simple questions to identify a bad clinic. You can get these answers by phone or by email, so you don’t even need to waste time and money on doing a consultation ! Please make sure you get the answers before you sign up, because after you have paid your money , you may get all kinds of answers that may not be honest.

The first question is does the clinic routinely give photos of embryos to all their patients ?

This is important because the thing an IVF clinic can do is make embryos. After we transfer them, whether they will implant and become a baby is not something which is in our control because implantation is a biological process that is notoriously inefficient and unpredictable.

Every good clinic takes pride in producing good quality embryos, and they are happy to provide photos to their patients so they can see for themselves that the clinic has provided high quality medical care. This means that if the clinic refuses to provide embryo photos , you need to worry about why they are hiding such important and valuable information from their patients ! The most probable reason is that the quality of care they provide is poor , which is why the embryos they create are of poor quality , and they don't want to share this bitter truth with their patients , because they are worried that they will leave them and find a better clinic.

The second simple question you need an answer to is: Do you do blastocyst transfers only for all your patients ? Now, I understand this is a technical term, and IVF patients are often not sure what the difference between an embryo and a blastocyst is. This ignorance can be expensive, because you do need to become an expert on your problem before starting an expensive IVF treatment cycle on which so much of your happiness depends . An embryo that is grown to Day 5 in the lab is called a blastocyst, and this has a much better chance of implanting , which is why all good clinics all over the world will only do blastocyst transfers for all their patients . This is because a Day 3 embryo does not belong in the uterus; it belongs in the fallopian tube, so it makes no sense to put it back in the uterus so prematurely. The stage at which an embryo reaches the uterus is only on day 5 , by which time it has formed a blastocyst and is ready to implant.

If you find a clinic that answers "yes" to both these questions, then you can be sure the clinic is technically competent, and you can be comfortable taking treatment there.

On the other hand, if the clinic does not answer yes to either of these two questions ( and you can ask the nurse or the receptionist for the answers! ), you should stay far away , because this is clearly a bad clinic that is going to hide information from you , and this is not in your best interests ! 

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 !

What are my chances of IVF success ?

 

One of the commonest questions every IVF patient asks at the time of a consultation is - Doctor, what are my chances of success ? This seems to be a very simple question , and one would expect that IVF doctors should be able to answer this easily – after all, we are medical specialists , with years of experience and expertise !

However, the reality is we can't answer this question, and the truthful answer is – No one knows . Unfortunately , this is not the answer which patients want to hear , and because doctors are smart , rather than be honest and tell them that no one in the world can answer this question accurately, most IVF specialists are happy to put a positive spin on the number and promise them the earth and the moon in the hope that they will sign up for IVF treatment in their clinic. This is why so many Indian IVF clinic websites claim exaggerated success rates of 80% and more !

The reason for our ignorance is because we cannot predict the chances of success for an individual patient in an individual cycle – after all, doctors aren’t fortune tellers, and the law of small numbers makes prediction impossible,

This is because embryo implantation is one of those biological variables over which we don't have any control - and if we can't control something , how can we predict what's going to happen ?

The trouble is most patients aren’t mature enough to accept this reality , and badger the doctor to provide some kind of a number . Doctors are very happy to pull a number out of a hat – and they know that the higher the number they quote , the happier the patient will be – at least for now !

The trust is this percentage ( and some doctors are happy to say it’s 90% !) is a meaningless number ! While clinics can provide a base rate – the probability of success in a group of women with a medical history similar to yours - the reality is that you don't care what happens to the 99 other women in the clinic - you only care about what happens to you !

This is why an “ 80% success rate “ is meaningless for an individual patient , because your outcome is going to be binary - it's either going to be 100% , or 0%. Sadly, most patients are innumerate, and don’t understand that statistics can be applied to populations , and not to individuals .

Unfortunately , doctors don't bother to explain this , and are quite happy to provide the patient with false hope and sweet talk them into signing up by quoting any number they want.

The harm this causes is that patients then have very unrealistic expectations of success , and then when their IVF fails, they go to pieces , and cannot gather the courage to try another cycle , so the false short-term hope causes long-term pain !

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 !

How to bounce back when your IVF cycle fails

It can be very hard to accept the fact that your IVF cycle has failed, because every patient does every IVF treatment with the hope that it's going to work !

Many women will repeat the HCG test multiple times, because they aren’t willing to confront this bitter truth, while others will go into mourning.

It’s important to be prepared to deal with failure , because it’s impossible to predict which cycle will succeed. Having realistic expectations and arming yourself with Information Therapy can help you deal with these ups and downs, and make you more resilient.

When your beta HCH comes back as negative, the first step is to learn to be kind to yourself . Please stop blaming yourself for the failure – this is not something that is in your hands. You need to allow yourself enough time, space, and privacy to grieve, so you can bounce back without indulging in an orgy of self-pity.

The outcome of an IVF cycle is uncertain and unpredictable, no matter how good the doctor, or how well the cycle progressed. You are not responsible for the failure , so please don’t allow other people to start blaming you . It’s very common for well-meaning "aunties" to explain the failure by saying that the embryo did not implant because you didn't rest enough, or because you ate something "hot", or because you lifted weights, or because you took on too much stress. They are completely clueless, so it’s best to ignore them. If they become too intrusive, ask them to show you their medical degree !

Please don’t blame your doctor either ! It’s hard to be kind to him, because he is a soft target, but good doctors want all their patients to get pregnant, and when the cycle fails, it can be distressing for the doctor as well !

After you have finished grieving, you need to learn to bounce back and think about the future. The first step you need to take is to review all your medical records especially your embryo photographs. If you don’t have photographs of your embryos, this is a major problem , because it clearly suggests that you have not received good quality medical care. All good IVF clinics routinely and proactively provide embryo photos to all their patients to document that they have received the best medical care.

You then need to get a second opinion based on your medical records,  so you can decide whether your current clinic is treating you well, and is  on the right track , or whether it's time to change your doctor.

Now you don’t need to reflexively change your doctor just because your cycle failed – but if the quality of your embryos was poor – or if the doctor refuses to give you photos of your embryos, you should definitely consider getting treatment from a better clinic that provides embryo photos routinely to all its patients and does only blastocyst transfers.

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 !