The teratozoospermia ( abnormal semen form) racket for "diagnosing " male factor infertility

A common racket we are seeing these days is for every semen analysis test to be reported as having teratozoospermia - the technical term for a large number of abnormal sperm forms/ shapes.

The truth is that most lab technicians don't actually know how to check for sperm morphology properly.

I suspect that they don't even bother to do this properly, and just report every semen sample as having a large number of abnormal forms to maximise their work load !

After all, when the report is abnormal, the doctor can triumphantly point out to this abnormality, and claim that this is the reason for your infertility !

The patient is very pleased that the doctor is intelligent, and has been able to diagnose the reason for his infertility ! 

The doctor will now prescribe lots of useless medicines - and some will even advice that the patient undergo ICSI treatment , which is expensive.

While ICSI is the only correct treatment for patients who actually do have teratozoospermia, the problem is that the diagnosis itself is incorrect in the first place !

Before accepting this diagnosis, please go to a reliable lab and insist that they give you a slide of your stained sperm, so you can be sure they have actually checked for sperm morphology properly . This is a time-consuming test, which takes a lot of expertise, and most labs cannot do this properly.

IVF video -busting the myth of bed rest after the embryo transfer

 

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Making sense of early pregnancy scans - part 2

When you can see your baby on the vaginal ultrasound scan, you are going to be very excited because you are one step closer to your dream of having your own baby.
However, the truth is that not every pregnancy results in a baby - and this is as true of IVF pregnancies as bedroom pregnancies. About 15% of all pregnancies will miscarry, and IVF does not reduce the risk of a miscarriage. These are usually first trimester miscarriages. 
Sometimes we can see the baby, but can't see a heartbeat. Please don't panic ! This is quite normal when the scan is done early, because the baby is very small, and it takes time for the heartbeat to appear. Often the doctor will advice you to repeat the scan after 1 week. However, if the baby measures more 5 mm ( this is called the CRL , or the crown-rump length), and we can't see a heart beat, this suggests the baby is dead. This is called an IUFD, or an intrauterine fetal death ( missed abortion). Read more at http://www.drmalpani.com/early_pregnancy_scans_atlas.htm
The commonest reason for this is a genetic abnormality in the fetus, and this is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which cannot be screened for.
There is no need to do a D&C for this. This can cause Asherman syndrome ( intrauterine adhesions). Read more at www.drmalpani.com/knowledge-center/articles/asherman. Ask them to terminate it medically with mifegest and misoprostol. There's no point in doing a genetic/ chromosomal study of the fetus/ products of conception, because this provides us with no useful clinically actionable information.
Even if you do miscarry, don't get disheartened. The fact you have conceived in the past ( even though you did miscarry) means your chances of having a healthy baby in the future are excellent.
For most IVF patients, the scans will be normal. We do them to reassure you that all is well, so you can relax and start enjoying their pregnancy. Please add your scan images to your embryo photos in your baby album !
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 !

Your embryo is safe in your uterus - like a pearl in an oyster

 

Even in this day and age , IVF patients still have all kinds of myths and misconceptions about embryo implantation . They worry that drinking tea or wine will damage the embryo; or that strong smells will reduce the chances of their embryo implanting. They want to know what foods they can take in order to increase the chances of embryo implantation , and that “hot” or “ cold “ foods will reduce the chances of pregnancy.  Sadly, a lot of these myths are propagated by clueless aunties; unreliable websites; and even doctors, who advice patients to take “strict bed rest” !

These are all myths. Let’s not forget that embryos implant  routinely in the uterus of fertile women all the time – after all, this is what they were biologically designed to do. When fertile women have sex in their bedroom , they don't know when they ovulated or when the embryo fertilized , and this makes absolutely no difference to their chances of getting pregnant.

Your embryo is not going to “ fall out “ of your uterus if you walk around !

Just because we have done IVF for you doesn't change anything at all as far as implantation occurs . The uterus is designed to allow for embryo implantation , and once your embryo is inside your uterus , it is safe , like a pearl in an oyster . You should stop obsessing about dos and donts  because none of your actions will either increase or the decrease the chances of your getting pregnant .

Please carry on with your life, and don’t make a bad situation worse by unnecessarily adding to your stress levels or by restricting your daily normal activities.

The abnormal sperm morphology racket for over-reporting teratozoospermia

One of the newest rackets we're seeing is that a lot of men are being reported as having male factor infertility due to abnormal sperm morphology - what is technically called teratozoospermia.

The irony is most lab technicians have no idea at all as to how to actually check for sperm morphology. There is a WHO Manual for Semen Analysis, which describes this process in great detail, but the vast majority of Indian labs don’t follow these guidelines, because it is very time-consuming and needs a lot of expertise.

To report sperm morphology properly, the sperm need to be stained , and the shape of each individual sperm ( for at least a total of 100 sperm) tallied. The technicians don’t have the ability to follow this, so they just take shortcuts. The biggest racket is they report the majority of sperm as being abnormally shaped – and label the patient as having teratozoospermia, without providing any details !

This scares the patient, because they start believing this means they will end up with having abnormal babies . Also, doctors now blame this abnormality as being the reason for the infertility, and will misdiagnose them as having Male Factor Infertility because of teratozoospermia. They will either treat them with some medicines ( which don’t help at all, but waste the patient’s time and money), or force them to do ICSI ( especially if it’s an IVF lab). 

This is completely uncalled for , so  please go into the details of the report and insist that you want to see the details of the abnormal sperm report. Just saying that there are 97% abnormal forms is completely unacceptable, and suggests the lab is incompetent and shoddy.

In any case, you should repeat it again from a better lab, which has the required expertise to do a semen analysis properly.

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 !

Making sense of early IVF pregnancy scans

IVF patients are very excited when their beta HCG is positive - they are finally pregnant, and can now start dreaming of holding their longed-for baby in their hands in a few months. 

However, the truth is that not every pregnancy results in a baby - and this is as true of IVF pregnancies as bedroom pregnancies. About 15% of all pregnancies will miscarry, and IVF does not reduce the risk of a miscarriage.

This is why we do ultrasound scans - to confirm your pregnancy is healthy.  Here is a simple flowchart to help you make sense of how the doctor interprets your pregnancy scan results.

Please note that all early pregnancy scans need to be vaginal ultrasound scans - abdominal scans don't provide enough details to make the right diagnosis. Vaginal scans are safe and will not hurt your pregnancy.

If the scan is done very early, the doctor will not see a pregnancy ( gestational) sac on the scan, because it's either too small, or it's not in the uterus ( if you have an ectopic pregnancy). Scans should only be done after  your HCG level is more than 1000 mIU/ml - doing it before this is pointless, because it's too early to see the sac.

If the doctor can see a pregnancy sac in the uterus, but cannot see an embryo/fetus inside the pregnancy on the scan, this is no reason to panic. Sometimes this is because the sonographer may not be skilled, or the machine may not provide enough  resolution. You should then repeat the scan after a few days - preferably at a more advanced scan center.

If the size of the gestational sac is more than 18 mm, and the doctor can't see a fetal pole, this is bad news and suggests you have an intrauterine fetal death. This is called an anembryonic pregnancy ( missed abortion). Read more at http://www.drmalpani.com/early_pregnancy_scans_atlas.htm

The commonest reason for a miscarriage is a genetic abnormality in the fetus, and this is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which cannot be screened for.

Do NOT do a D&C for this. This can cause Asherman syndrome ( intrauterine adhesions). Read more at www.drmalpani.com/knowledge-center/articles/asherman. Ask them to terminate it medically with mifegest and misoprostol

Even if you do miscarry, don't get disheartened. The fact you have conceived in the past ( even though you did miscarry) means your chances of having a healthy baby in the future are excellent.

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 !

Malpani Baby Self Insemination Kits - Video to help infertile couples to treat themselves

 

Why it's easier to treat unexplained infertility rather than to diagnose it. Video on Unexplained Infertility by Dr Malpani

 

The paradox of unexplained infertility - treatment is easier than diagnosis !

Whenever infertile couples go to the doctor, they expect him to make a diagnosis , so he can tell them what the reason for their infertility is. They know that once that's been established, the doctor can treat this and they can have a baby.

The reality is that we can't always find the cause for infertility in some couples. This is true in about 1 in 10 couples, and they are diagnosed as having unexplained infertility . This is really a non-diagnosis, and this frustrates patients. They feel the doctor is useless because he can't even find out what their problem is. Their biggest worry is that we can't find out what the problem is , how will we able to treat it ?

The reality is that the diagnosis of unexplained infertility just means that our technology is not good enough to pinpoint where the problem is. The good news is that our technology is good enough to bypass any problem !  At the end of the day , we shouldn't care about problems – we should only care about solutions ! 

Unexplained infertility simply means that all the basic tests have been done , and everything has been found to be is fine. In fact, you should be happy that everything is normal, so don’t get upset please ! 

Even though we have not been able to find out exactly what the problem is, but we can still increase the chances of your egg and sperm meeting, so we can give you a baby. Treatment options include IUI and IVF , and there's no need to get distressed or upset if you are young, as the success rates for treating unexplained infertility are very high.

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 !

Queries about using the Malpani Baby Kit for Self Insemination

Patients often have many questions about how to use the Malpani Baby Kit for Self Insemination.

Here are the answers.

" We are planning for baby due to painful sex. We are trying home insemination. Through Youtube , we tried with a syringe last time . What we observed is almost all the liquid injected into vagina was coming out along with the syringe when it is pulled out. While surfing we came across your video and we are planning to buy your DIY kit. Have a few queries could you please provide your inputs.

1. With your kit ,when we insert the speculum ,won't it cause burning or pain inside vagina ? In that case can we use lubricant provided in your kit to apply on speculum or please suggest how to loosen vagina. I don't get lubrication properly.

You don't need to use the speculum if you don't want to. It's easy to insert the soft plastic pasteur pipette deep into your vagina . This will automatically deposit the semen near the cervix.

2. Through the pipette should we drop semen near the cervical opening or should insert pippet slightly to cervix opening.

Near the cervix is fine. Sperm can swim and will find their way to the cervical mucus, so please don't worry about this

3. With my previous experience injecting through a syringe I noticed almost all liquid came out of vagina, what should we do to make semen stay inside vagina.

Lie down with a pillow under your hips for a few minutes after the insemination

Leakage is normal . This happens after sexual intercourse as well, because the vagina is a closed blind tunnel/sheath

4.After sperm ejaculation how long the sperm should be kept outside, I mean should we wait before inserting into vagina after semen collection.

15 min is enough for it to liquefy

5. Is it necessary to get naturally lubricated inside vagina and get orgasm during this process ?

No, there is no relationship between sexual arousal, orgasm and fertility

5. Can the kit be delivered to my hometown which is small taluk in Karnataka.

Yes

You can buy the  Malpani Baby Kit for Self Insemination. online !

The endometrium and infertility - what every infertile couple needs to know about the uterine lining

For an infertile couple, it can be quite scary to go to a doctor , because doctors use a lot of medical jargon .

Many of these are difficult long words, which are hard to pronounce, and which they have never heard before. The problem is compounded by the fact that most doctors never bother to take the time and trouble to explain the meaning of these terms.

One of these foreign words is the endometrium . Yes, this is quite a mouthful, but it’s just the scientific word for the inner lining of the uterus . Endo means inside , and metrium means uterus , so don't get confused .

If you are willing to be patient and do your research for yourself, it's very easy for you to get up to speed , because understanding the problem of infertility and its treatment is not very complicated.

After all, you only need four things to have a baby – normal eggs, uterus , sperm and fallopian tubes.

If there is a problem with the uterus lining or the endometrium, then this is easy to diagnose, using vaginal ultrasound scans.

The endometrium gets shed during the menstrual period as the menstrual flow, and at this time, the lining is thin. The uterine lining grows in response to the estrogen produced by the follicle during the follicular phase. Prior to ovulation, the  endometrium is about 8 mm in size, and trilaminar in texture. This is reassuring, and suggests normal endometrial function.

In case the lining is thin, or distorted on the scans, this suggests there may be a problem with the endometrium , and the doctor can do a hysteroscopy to confirm this. Many of these problems - for example, an endometrial polyp, are easy to fix , provided you don’t allow the doctor to bulldoze you by using a lot of fancy medical terms which are designed to confuse you, rather than enhance your understanding.

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 !

Tubal (ectopic) pregnancy - so near and yet so far !

Being infertile is bad enough, but one of the biggest tragedies is when you get pregnant, but the pregnancy is not in the uterus , and is lodged in the fallopian tubes. This is called an ectopic or tubal pregnancy. Implantation just a few centimetres from the right place can make such a big difference !

The risk of an ectopic pregnancy is higher in infertile women , because often their tubes are partially damaged ( even though they are open, they may not be functioning properly). Sadly, we can't prevent this.

You can have an ectopic pregnancy even after doing IVF , because even though we're transferring the embryo directly in the uterus, it can travel backwards into the fallopian tubes and get stuck there.

The problem with an ectopic pregnancy is that the fallopian tube is not designed to allow a baby to grow , and if the diagnosis is delayed, the tube can actually rupture, and this can be a life-threatening complication .

This is why it's so important to monitor the early stages of pregnancy in infertile women. You should test for pregnancy as  soon as possible . The doctor will monitor you by checking your blood HCG levels and doing ultrasound scans , so that we can make a diagnosis as early as possible.

The good news is that if this is done in a timely fashion, we can kill the ectopic pregnancy with a simple methotrexate injection, so you don't need a laparoscopy , forget about open surgery. The bottom line is that an ectopic pregnancy is a problem which is easy to treat , if diagnosed in time.

The tragedy occurs when the doctor fails to consider this possibility, which is why patients need to be well-informed, and ask the doctor to rule out an ectopic. This can be tricky, because the symptoms of both an intrauterine pregnancy and an ectopic pregnancy are exactly the same, which is why you need to be proactive, and ask for the blood tests and scans.

Read more at http://www.drmalpani.com/knowledge-center/articles/ectopic