Sunday, October 04, 2009

What makes us different ?

I saw a patient who had had 4 failed IVF cycles and was quite fed up and frustrated. On reviewing her records, I felt she had received poor quality care, and was quite confident that we would be able to do a much better job !

Her question was simple - Doctor, how are you any better than all the other IVF clinics I went to ? Every clinic calls themselves the best ! How are you different ?

This is a very thoughtful question - and deserves a careful reply. After all, every patient tries to find the best IVF clinic for their treatment - what makes me think that we are their best
choice ?

First of all, I agree that we are not the best choice for all patients. After all, we cannot be everything to everyone !

Thus, I don't think we are a good choice for the following patients .

1. Those who are looking for a bargain or for cheap treatment. There are may clinics which charge less than we do - and we don't try to compete on price. While we don't overcharge , we are fairly expensive , but we think we are very cost effective because of our high high quality treatment and high success rates.

2 . Those who are reluctant to travel to find the best possible clinic. For them, their best option is to find a local clinic, even if the technology is not state of the art and the success rates are lower.

3. Those who want a fertility specialist and obstetrician rolled into one. Many patients want a gynecologist who will get them pregnant and also take care of them during their pregnancy and child birth as well - someone who provides a " comprehensive" point- to- point complete service. We don't. We are a highly specialised IVF clinic - a focussed factory, so to say, which does only IVF - and does this very well

4. Those who are looking for simpler treatment options. We are a very good IVF clinic, and providing simpler infertility services such as IUI ( intrauterine insemination) is not our forte. IUI is a very basic treatment , and we suggest that patients who want IUI should find a local doctor to do this for them, rather than come to us, so we can focus on our core competence.

5. Finally, patients who expect their doctor to tell them what to do are not good patients for us. I am not a veterinarian, and we take pride in empowering and educating our patients, so they can make the right decision for themselves . We don't like treating patients who tell us - You tell us what to doctor ! We prefer patients who know their own minds and who are capable of partnering with us.

However, we would be the best fit for patients who match the following criteria.

1. Patients who have failed IVF cycles elsewhere. We love getting these patients pregnant ! It's a matter of professional pride to us when we can give couples who have failed many IVF cycles elsewhere a baby. We devote a lot of time and attention to these patients, because they are challenging - and we love taking on challenges ! This is because we are competitive and driven. Since we have been doing IVF ( and only IVF) for the last 20 years, we are very good at what we do . We have a lot of experience, and can tailor and individualise the treatment plan to suit our patient's needs ( rather than use a cookie cutter "one size fits all" mindless protocol.)

2. Patients who are fed up of having non-communicative doctors who keep them clueless and don't provide any information. We spend a lot of time and energy in educating our patients. We expect them to take an active interest in their treatment - and though we don't try to make them IVF specialists, we do expect them to understand the difference between follicles, eggs, embryos and blastocysts ! We explore clever new technology tools ( such as e-learning courses, comic books and videos ) to try to make the learning entertaining and engrossing.

3. Patients who want a doctor who will respect them; talk to them and treat them as intelligent adults. We do this all the time. We are very transparent - and I encourage patients to email me with their queries, so we can resolve their doubts and hold their hands in their journey

4. Patients who want transparency. We make it a point to show patients their ultrasound scans and their embryos. We involve them in their treatment, so they know exactly what is going on - even when things are not going well. For example, we always photograph their embryos and provide this as documentation to them, so they know they have received high quality treatment.

5. Patients who want personalised attention . This is our forte. Dr Anjali and I are the only two doctors in our clinic . We take care of all our patients ourselves. I do the consultation and formulate a treatment plan; Dr Anjali does the ultrasound scans ; monitors the superovulation closely ; and does the egg collections; while I do the transfers. We do not have any assistants and we provide all the care ourselves, hands-on. There is no delegation and together, we make a great team - and patients get two opinions ( for the price of one) ! Also, husbands often find it easier to talk to me; while the wives find it easier to talk to her.

6. Patients who want a clinic which uses cutting edge technology. We pride ourselves on our state of the art equipment and lab. Dr Sai, our embryologist, is extremely competent and efficient - and we offer all the latest advances, including vitrification; laser assisted hatching; PESA and TESE; embryo biopsy and PGD; egg freezing ; and blastocyst transfer.

From a medical point of view, we are a very good first choice for the following groups of patients.

1. Older women. Many of our patients are older women with poor ovarian reserve, who have been refused treatment in other clinics. Even if they have a lower success rate, we are happy to treat them, as long as they have realistic expectations. We can be very aggressive with our superovulation protocols; and are happy to use alternative medicine to help the improve their chances.

2. Women with PCOD. These are often challenging patients, because it's very difficult to superovulate them. When they grow eggs, they often grow too many, which is why many doctors do not go a good job with superovulating them. Because they are so scared of ovarian hyperstimulation syndrome ( OHSS), they often end up coasting these patients or mistiming the HCG injection, as a result of which they get few eggs and poor quality embryos. We have extensive experience in doing IVF for PCOD patients, and our pregnancy rates are better than 45% per cycle for PCOD patients. You can read more about this at !

3. Patients who need donor eggs and donor embryos. We have a very active donor egg and donor embryo program; and because we are so busy and experienced, we can find suitable donors quite easily.

4. Male factor infertility patients, with severe oligoasthenospermia and azoospermia. We never give up on these patients ; or push them into using donor sperm, a very common copout with many IVF clinics who have little knowledge or experience in dealing with infertile men ( who are usually farmed out to a urologist ). We offer a very effective ICSI program; and will aggressively look for testicular sperm, even in men with testicular failure, using Dr Rupin Shah's minimally invasive TESE technique.

5. Patients who want the freedom to make their own decisions . We offer only non-directive counselling - and we never tell patients what to do . Thus, we are happy to treat single women; lesbians; and HIV discordant couples .

Our core competence is that we pamper our patients - and this is what sets us apart from the rest !

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