How Clinkare helps to improve a doctor's efficiency !

Clinkare is a clever EMR made by Plus91 ( in which I am an angel investor). I like the fact that Clinkare helps to improve a doctor's productivity by using technology.

For example, a problem all doctors have to deal with is that of "no-shows". As a doctor said, " My patients forget about their appointments resulting in no shows or them coming late causing my schedule to go haywire."

With Clinkare you can now SMS directly from the appointment register a reminder to the patient well in advance on the same day about the appointment and avoid any delays. You can also generate reports on how many patients came late and if there are any persistent latecomers , you can take identify them and deal with their tardiness.

Waiting for the doctor

This is a guest post from a very thoughtful patient of mine. I know many IVF patients will be able to identify with her experience . I just wish more doctors would read this as well, so they can provide more support to IVF patients !

When you do ivf as a medical tourist soon you'll find out you have become a traveller between the worlds. Between continents and between medical worlds: "normal" obstetrics and ivf. Unexpectingly it turns out to be much easier finding an ivf doctor in India than finding an obstetric gynecologist in your home town. And once you are lucky enough to get an appointment, you are faced with different treatment concepts: pregnancy in obstetrics and pregnancy in ivf are a world apart it seems.

Unless you are already established with an ob gyn - not so likely; you would not be an ivf patient if you had made it into the normal gyn world - getting an appointment with a gynecologist becomes a real challenge.

After returning from India I called a gyn I had seen once to schedule appointments for the row of betas after the two week wait. She reluctantly ordered one blood test and told me right away that she was not willing to deal with ivf patients in general, much less with ivfers from abroad and that she was not an obstetrician anyway for that matter.

I then contacted other obgyns in my area but they were so fast in telling me that there were no appointments available any time soon that I did not even had the chance to explain the vital importance of the row of betas in ivf and that this was why I needed an appointment much sooner. Since this was my fourth ivf cycle, as a recurrent ivfer I had by now acquired a daunty respect for those fearful beta numbers and their always heart-wrenching doubling time. During the two weeks of wait for the first beta, the tension grows denser and denser and the only thing that can ease your strain, slightly, is a good doubling time. I had to find a beta-willing gyn at any cost.

A certain familiarity with the medical establishment led me to the conclusion that local doctors in private practice might have arbitrary freedom as to wether accept new patients and therefore insisting on small private practice doctors would lead nowhere. I had to find a public structure with more inclusive patience acceptance. I called the medical faculty associates office at a the local university. Among the options at the answering machine : "if you are pregnant ..."That sounded promising.

I pressed the required key and a friendly voice said, he would now check for available appointment dates. I explained right away that I was doing ifv abroad and that I needed two blood tests and a scan done on specific dates. He was listening for a while and after what seemed to me a long stretch of silence he was trying to find out where in his scheduling scheme I could possibly fit in with my outlandish request for a row of betas. "A row of betas ? I don't think the doctor will do that for you". He appeared to want to be helpful, but just could not comprehend my urgency for blood tests. He suggested to do a home test in the meantime.

I did not want to lecture on the difference between qualitative and quantitative bhcg testing for fear this might ruin his sympathetic attitude towards me. I just began to understand myself that timing in ivf was far away from timing in normal obstetrics. The beta frenzy was a thing exquisitely ivf. He was willing to give me an appointment to see a doctor on a day that luckily turned out to be the day my ivf doctor wanted me to have my first scan, in 10 days to come. I gratefully accepted. I had to find another way to find relief from beta hell. There was no way I could wait 10 days without knowing my beta numbers' fate.

When dismissed from Dr. Malpani's clinic, he will ask you to inform him on your beta results. I emailed him that I was not able to obtain blood tests and therefore could not inform him. Within a few minutes he replied sending me a link to a online lab. What a relief. I would have had to pay for the tests privately though. Relief from awful beta-anxiety has no price.

The beta numbers came in, anxiety stayed. Doubts about adequate doubling time and no doctor to talk to. Again I emailed with Dr. Malpani and was reassured.

While my appointment with the obgyn was approaching, I imagined that I would have to go through at least two assistants before I could talk to the doctor. They would both ask me the same questions again ,checking the same checklist. Why was I so hypercritical ? I should be thankful that someone was paying attention to me no matter how formal.
This doctor turned out to have one assistant only and she was indeed simply friendly and asked me where I had my ivf done. "India ? That's pretty far away".
"Only on the map" I replied thinking of how easy it was to get advise from my ivf doctor by email while I hadn't yet seen the local doctor. I was so tense about seeing the doctor and whether he would have me have a scan done, that I made no attempt to explain this apparent contradiction. Whatever her assumption regarding my state of mind that moment , she was surely right.

And then she asked me about the due date. The due date ? WTH ? Heavens, I am doing ivf ! I am not in the usual pregnancy business. In ivf the due date is an almost non-existing concept. In ivf you go from hurdle to hurdle, from beta to beta, from scan to scan, day by day, week by week. The relief of one doubling beta lasts the blink of an eye and you start worrying about your next beta two days from now. And once you made it to the ultra sound level and you are lucky enough to see what could be a a gestational sac, a black little hole, you start getting very nervous when your next appointment approaches: will there be a heartbeat ? You will never forget that flimsy flickering filament and life appears to be so fragile and delicate, a friable thread of silk.

"The due date", I said, "I never got that far". A look at her told me that she considered my situation to be too complex. She did not inquire and I was glad I did not have to go over my ivf history. I handed her my discharge papers. Without having a look at them she said the doctor would be here soon and left.

The doctor stepped in, I explained I was doing ivf abroad. I told him my beta numbers and he decided they were too low. The feeling of desperation took over. I had the impression that maybe he was not used to see beta numbers at such an early stage of pregnancy and that was why he considered them too low. But I had not enough energy to find that out. I would ask Dr. Malpani.

By now I have become an established patient with both the pregnancy worlds. Pregnancy symptoms might be the common interface. I learned to navigate myself through the "normal" obgyn world being aware that I am confronted with a somewhat different obstetric culture. There is no "clash of civilization" in obstetrics, no self-fulfilling prophecy of conflict. After all, a pregnancy is a pregnancy, no matter where.

Indian surrogate business raises issues - LA Times

Meanwhile, financial irregularities and ethical shenanigans have increased, fertility experts said, because profits are huge and any doctor here can in theory become a fertility specialist overnight.

"Today, unfortunately, even the smallest clinics are doing surrogacy because it's a simple procedure and four times as profitable" as other fertility treatments, said Dr. Aniruddha Malpani, a fertility specialist in Mumbai. "Some aren't up to the mark, and foreigners get fleeced."

How to prescribe Information Therapy to prevent medical errors

How to prescribe Information Therapy to prevent medical errors

View more presentations from Aniruddha Malpani.

What the American Health Care System Can Learn From Denmark

" In Denmark, we’ve developed communication thus far for almost all IT systems in the health sector. We have implemented all prescription and medication information, and all discharge letters and summaries from hospitals. This also includes outpatient notes, injury reports, x-ray reports, lab reports and lab orders. Reimbursements from health insurance have been made electronic, along with referrals to hospitals and private specialists, and referrals to psychologists. All private physicians have electronic health records today so they can communicate and transfer documents electronically, as well.

From the beginning it was a grassroots effort; we thought it was a good idea to exchange information electronically. And now it has become mandatory that you must communicate electronically. There was a state-wide agreement that this was a good idea."

Patients as consumers

" Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.

What has gone wrong with us?"

What people do not realise is that when patients start behaving as consumers, the doctors you deal with will stop behaving as trusted professionals and will start behaving as businessmen who will focus on their bottomline. When you are ill, you need a trusted advisor - and if you do not treat your doctor as a healer, he will not behave as one. What a shame that it's come to this !

Doctors as online trusted patient educators

" Guiding patients to better online sources of medical information should be a new physician responsibility for the digital age. Not only should doctors expect and be receptive to questions patients raise from Web research, they need to proactively engage patients online in order to dispel falsehoods and guide them to legitimate sites."

This is why I feel every doctor should have their own website ! It forces them to search for reliable health websites ( to which they can link) so they can guide their patients intelligently, rather than getting upset when patients come with many sheets of internet printouts ! Even better, it will encourage thoughtful doctors who are not happy with the quality of the information they find on other sites , to publish better customised content on their own website, thus helping lots of
other patients !

Complaints about doctors

" Second, anonymous reviews should not be allowed. Not only can anonymous posts be manipulated by someone bearing a grudge, glowing narratives can be planted by a doctor or his staff. Ratings accountability allows doctors to use real patient feedback to constructively improve their practice. Angie’s List, a leading fee-based consumer rating service, sets an example by not allowing anonymous reviews of health professionals."

I agree ! It's very easy for a disgruntled patient to write a complaint about Dr Malpani - and I am sure our friendly competition may even egg on their patients to do so . These kind of complaints can cause a lot of damage and are very hard to fight, because the poster is anonymous - and can say what he likes and get away with it !

Doctors and social media

" And perhaps more important, doctors who fail to embrace social media risk becoming irrelevant, as more patients flock to the web as a source of health information, rather than endure the inconvenience of a doctor’s office:

Doctors who are not active online risk being marginalized. Facebook and Twitter users, half of whom are under of age of 34, rely on the web for most of their information. As this demographic ages, it’s conceivable that they will consult social media first to answer their health questions."

In the past, senior doctors had an edge over their juniors because of the "grey-beard" syndrome. Times are changing and doctors need to evolve with them ! Patients will usually go online first when they have a health-related problem - and doctors who are not online may soon find that they have become dinosaurs, who can no longer survive !

Interactive Health

" Interactive health is about making health knowledge, supportive care, and motivation available to us, anytime and anywhere, so that we can integrate this wisdom into our daily actions to live longer, healthier, happier lives. Welcome to the new era of Interactive Health."

We are very nearly there now ! Everyone will have their PHR in the cloud; doctors and other medical professionals will use their EMRs to upload your medical data to this PHR, so that the medical information is automatically updated and complete. You can share portions of your PHR with others - and your doctor can prescribe Information Therapy to you, tailored to your needs !

Why doctors should refer patients to other patients !

When doctors are stumped with a difficult patient, they will often refer the patient to a specialist, in order to help them with the diagnosis and management.

However, while specialists can be very skilled at making the right diagnosis, they are often not very interested in helping the patient to learn to live with his disease. This is not an area which is of much interest to them, and not their core competence either.

However, after the diagnosis has been made, the patient's life still carries on - and he is often unsure where to turn for help.

For example, let's look at a young woman who goes to her family physician with the problem of blurring of vision. The physician dutifully refers her to an ophthalmologist, who then sends her on to a neurologist, who makes the diagnosis of multiple sclerosis. The doctors pat themselves on their backs, for having come to the right diagnosis so efficiently - and the patient is grateful that at least now she knows what her medical problem is. However, she still has to learn how to live with MS, and learning how to cope with a chronic illness is often the hardest part of having MS.

Unfortunately, this is something about which none of her doctors is well-informed ! The neurologist knows a lot about demyelination and how this affects nerve function - but he cannot teach her much about how to come to terms with her illness ; and how to manage her activities of daily living. How does she deal with her fatigue ? with a cranky child ? arm weakness ? her fears that she may become wheel chair bound ?

The best source of this expertise is not going to be a doctor - it's going to be an expert patient - someone who has lived with MS for many years, and is willing to share their heard-earned wisdom and experience.

Good doctors have always done this informally for many years - and it's been proven that support groups are a great way of helping patients to cope with their illness. It's now also possible to have online support groups, where patients can reach out and connect with each other.

Doctors can also learn a lot from expert patients. Thus, while a diabetic specialist knows a lot about the metabolism of insulin and how to program an insulin pump, he may not know much about what you need to do about your diet and activity in real life ( for example, when you have to attend a marriage or go out for a holiday). You may think these are "silly questions" and may not want to bother your doctor with these trifles - but the fact still remains that you need reliable answers !

It's best to learn these pearls of wisdom from other patients. They will be much more
empathetic - and their advise is likely to be much more practical, as it is based on their real-life experience - not on what a text book says ! Also, while it may not always be reliable ( because patients can be poorly informed sometimes), at least you know it will be provided with no vested interest !

PEAS Healthcare and patient education in India

While patients in the US are deluged with information, patients in India are usually starved for this. They have to depend upon US websites for information ( much of which is not applicable to Indian conditions and diseases); or upon their doctor ( who is often too busy to educate them !)

One of the major issues is that the importance of educating patients has still not become a pressing issue for doctors. Traditionally, Indian doctors have always been quite paternalistic; and most Indian patients are quite happy to follow the doctor's orders.

While it's true that times are changing, and that the younger generation of doctors is more willing to be open ad to invest time in discussing treatment options with their patients, another limitation has been the acute shortage of patient educational materials designed for India.

Another major issue has been the fact that there are so many regional languages in India - and many Indians are illiterate.

The good news is that this challenge is actually a great opportunity - and clever startups like PEAS India ( in which I am an angel investor) are now developing a library of patient educational DVDs , customised for India !

Why I'd trust an expert patient more than a doctor

This may be a terrible confession for a doctor to make, but when I have a medical problem, I'd trust an expert patient rather than a doctor. Let me explain.

I have chronic back pain and this can be quite severe at times. However, I am very reluctant to go to an orthopedic surgeon, because I know pretty much what he is going to say. He's going to do a cursory examination and then ask me do do a MRI scan. The MRI scan will find some bulges in my intervertebral discs - and the radiologist will happily report this as prolapsed intervertebral disk ( slipped disc, in layman's terms). The doctor will be happy he's made the right diagnosis; and will advise bed rest; pain-killers ; and physiotherapy - with the caveat that if it gets worse, he'll be happy to do "minimally invasive surgery" to fix the problem.

This is the standard medical paradigm for managing back pain - and while it's completely reasonable ( and follows medical textbook advise) , it's does not add to the quality of my life. I want to continue playing tennis daily - and want advise on how to manage my back pain without having to stop my tennis ! This is not something most orthopedic surgeons know much about, because they spend more time in the Operating Room than on the tennis court !

I'd much rather talk to a tennis player who has had back pain for many years, and ask him how he's managed it. He is the true expert on my problem and I'd be happy to learn from him. For one, his advise would be much more applicable to my problem - and for another, he has no hidden agenda !

Of course, not every patient is an expert patient. I want someone who's smart, well-read and well-informed - and who has taken the time and trouble to explore his options. ( If he also happens to be a doctor, that's an additional bonus !)

While doctors are good at making the right diagnosis, how to live with the disease ( how to manage what medical textbooks call "activities of daily living" ) is something patients can learn much better from other patients. This is not an area in which doctors are well-informed , because it's not something which interests them !

Really smart doctors will refer their newly diagnosed patients to other expert patients , to help them cope better with their illness !

Doctors, patients . teaching and learning

As i have written earlier, the primary job of a doctor it to teach patients. After all, medical care does not just consist of making a diagnosis or prescribing a medicine. Teaching patients about their illness; what they can do to manage it; and what they can do to remain healthy is an integral part of a doctor's job.

However, as important as teaching is learning. Doctors need to learn all the time. Medical science makes dramatic advances all the time, and doctors have to invest time, money and energy in ensuring they knowledge base is updated and current . This is why doctors read medical journals and medical conferences !

However, a very important teaching tool ( which many doctors sometimes overlook) are patients. Patients can be your best teachers - if you give them an opportunity to teach you ! Patients will not teach you just about the medical details of the disease ( though reading medicine about patients you have actually seen is the best way of making sure that the knowledge "sticks" !) .

Patients can teach doctors how to live; and how to cope with adversity ! Expert patients know a lot about their disease, and can teach a doctor a lot about how his patients can learn to live with their disease.

( And if you are lucky, and your patient is an investment consultant, he can also teach you how to invest in shares and stocks ! )

PGD - CGH - is it of any use ?

The newest IVF technology uses a fancy new technique which marries IVF and genetics. This is called PGD ( preimplantation genetic diagnosis) with CGH ( comparative genomic hybridisation) and there are lots of press releases and articles touting this as the newest breakthrough !

Doctors , like all big boys, love to play with new toys - and the newer the better ! This is especially true when they have expensive new technological tools, which no other competitor has. Doctors can be very competitive - and are always trying to be one-up on each other. An easy way of being different is to use the newest technology - but the trouble is that never is not always better ( though newer is always more expensive !)

Because these new tools are so expensive , doctors need to use them extensively, to justify the expense - after all, they need to show the bean counters who pay their salaries and bonuses that the new tool is cost effective !

The key question thoughtful patients need to be asking is - Is it really better ? Or is it a solution looking for a problem ?

I think the truth is we really don't know right now ! It's very likely to be useful for some patients - but to expect it to be useful for everyone across the board is hoping for too much ! While it may seem logical to use PGD, unfortunately, biological systems are not always logical ! What seems to make sense in theory often does not

As a doctor in clinical practise , whose major focus is simply to get as many of my patients pregnant as quickly as possible, I am quite conservative and prefer to wait and watch.

I follow Alexander Pope's dictum,
Be not the first by whom the new are tried,
Nor yet the last to lay the old aside.

Only time will tell how useful PGD-CGH is - but the enormous commercial pressures under which IVF clinics operate - and the constant demand by patients that their doctor use the newest and the latest breakthrough technology they read about in the newspaper means that most IVF clinic will likely end up overusing it !

Preparing for the worst

I always tell me patients to prepare for the fact that their IVF cycle may fail. Many patients dislike this. They feel I am being too negative - and are secretly worried that such negative thoughts are a jinx which will jeopardise the outcome. Most patients want a cheerful optimistic doctor who will promise them a baby.

Intelligent patients appreciate my honesty and frankness - they prefer a doctor who will tell them the unvarnished truth. Others who cannot handle the truth will usually move on to another doctor who is willing to promise them the moon - and who is happy to tell them what they want to hear !

It's very easy to smile; be optimistic - and make false promises. Everyone wants to think positive - and if you believe the book The Secret, then positive thoughts attract success !

While I am personally very optimistic by nature, I feel it's not correct for a doctor to overpromise success ! Patients are emotionally very vulnerable and it's easy to take them for a ride - something which many unscrupulous IVF doctors do all the time, by quoting inflated success rates and promising the moon !

When I tell patients to prepare for the worst , this does not mean that I not hopeful or that I am a defeatist. I am not being negative or being a pessimist - I am just trying to be a realist !

Being prepared does not mean that you are expecting a bad outcome or that your negative thoughts will attract failure - it's just that you are preparing for it. This is something you do in daily life all the time , so why shouldn't you do it during your IVF treatment as well ?

It's always easier to mentally prepare when you do not need to !

Let's assume to decide to be positive, optimistic and upbeat and prepare only for a good outcome. If you do get pregnant, you'll be pleased and happy - and life will move on. However, if you do not get pregnant , you will go to pieces. Bouncing back will be much harder - and you'll find coping with the emotional roller coaster ride much more difficult.

However , if your prepare for a bad outcome and get pregnant, you get double the joy ! And even if you do not get pregnant, while your heart will still break, your mind will help you heal faster because you were mentally prepared for this.

It's harder to deal with a negative outcome when you are not ready for it ! IVF is a scary emotional roller coaster ride and mental preparation gives you some stability.

The trick is to find the right balance - to look for the middle path - what Buddha called the golden mean ! It can be helpful if both partners have different world views because they can balance each other !

However, if the husband is optimistic and the wife is pessimistic, and the cycle fails, he may end up blaming her for the failure because " you are always negative" ! Victim blaming is very common when patients adopt a pessimistic approach in order to protect themselves from heartbreak - and this is just adding insult to injury !

Why I love being an online IVF specialist !

This is a guest post from Carina Freeman, the Fertility Coach.

I think it's time to take the time and share my story. To help you understand why I am passionate about Hold your Hand fertility coaching.

In 1997 I was able to conceive a son with no problems at all. I had no idea what my future would hold. I have always had very severe menstrual cramps. However, I never went to get them checked out because I thought it was "normal." My mom, her sisters, and their mom also had severe cramps. I always wanted more children after my son was born in 1997, but thought maybe it just wasn't my time yet. So, we kept trying for years with no success. This made me feel like less than a woman. Why could I not give my husband a child? After several years, my husband suggested I go to the doctors to have myself checked out. In 2005 I decided to take the 1st step. This step would lead to my documented fertility journey.

My doctor did a "normal" fertility work up (blood work and exam) which came back "unremarkable". At that time he questioned me about my family history and my severe menstrual cramps. From my family history he came up with a possible diagnosis of Endometriosis. This was something I had never heard of. So, I began to research this subject on the internet. My research gave me different answers with m any poss
Still, wanting to bear another child of my own, my physician said IVF would be my best choice. Of course I had to do my own research so I asked several of my MD friends and they all agreed. I read every book that I could find about IVF and realized that would be my best chance to complete my family. A few months later, my husband went to Iraq for his second tour of duty. I felt alone. I felt like no one understood what I was going through. Depression was starting to set in. The "why me" thought was always present and in front of my thinking. What did I do wrong? I felt like less of a woman for not being able to have another child. Living in a military town, it seemed as if EVERYONE around me was pregnant. I couldn't go to the grocery store without seeing a pregnant woman. Why and how can SHE have so many kids, and why not me? The pressure from my mother for a grandd
That was not the change I needed. In fact it left me feeling even more alone. Not even a trained counselor could help me. Since I love to read, I found lots of great books on positive thinking. I learned the art of meditate and the art of training my thinking. I then realized my negative thinking was indeed harmful! That HAD to change! Having negative thinking for so long, it's was VERY hard to change on my own. Luckily, I found a great friend, she was going through infertility too! Together we began to work on our negative thinking, and began to get our minds and bodies ready for this great adventure! It wasn't an easy change, as change rarely ever is. However, now I know it was extremely necessary. We began to work on our diet, while putting our thoughts on a "diet" as well. Finally my husband came home from war. We began to talk about IVF and how we would pay for With a new way of thinking, and feeling confident that IVF would work for us, I began to research different IVF clinics. I came across lots of great US clinics, but one clinic in Europe for IVF caught my attention. Together my friend and I (and our husbands of course)
took a 2 week trip to Europe.

In 2008, after one IVF treatment, I was PREGNANT! I gave birth to perfect babies; a boy and a girl. My friend also got pregnant on her first IVF attempt with twins!
Through out my pregnancy I kept a IVF diary made very public on you-tube. http://www.youtube.com/user/Medicluvstrauma?feature=mhum

My education continues every single day to help you educate you. Dr. Google has good information but is not always the best. With my dedication, knowledge, and compassion to help others, I will be here for you in every aspect!! My way of coaching is like no other. I help bridge the gap between your mental and physical health by helping you find your true self, teaching you how to train your thinking through meditation and other channels, and getting you ready for a successful pregnancy.

Thank you for listening to my story!

Sincerely,

Carina

Throughout my journey there was on online doctor that went above and beyond with the free information he offers. He deserves to be recognized for all he does for the infertility community. Please check out his website and grab the free information he provides. He also provides an infertility cartoon!! Please take a look.

www.ivfindia.com

Thank you so much Dr. Malpani !!

Conference on Preventing Medical Errors in Mumbai - 24 April 2011

Medical errors are a leading cause of preventable deaths. When a patient dies because of perceived medical negligence, hospitals get burnt down and doctors get beaten up. However, not all deaths are because of negligence - and not all errors can be prevented. In order to learn about what we can do to make sure that medical errors are minimised , India's first Patient Safety Workshop is being organised in Mumbai. This is the first conference in India which focuses on this key issue, which is usually misunderstood; and often ignored.

I am especially excited about the fact that this workshop will be involving patients as well, as I deeply believe that well-informed patients can play a very important role in preventing medical errors !

We've got some great speakers - please do come and join us ! You can get more details by emailing [email protected] !

NB Nrip, thanks for pointing out that there is an error in the conference announcement - it is on 24 April . Just shows how easy it is to make errors :)

The website for the conference is at http://thepatient.in/safety/

I have a low AMH level - what should do I do ?

For infertile women, AMH ( anti-Mullerian hormone, also known as MIS ( Mullerian inhibiting substance) has become the standard marker for egg quality . It provides us with a quantitative measure for checking ovarian reserve, and measures both egg quality and quality. You can read more about this at www.drmalpani.com/knowledge-center/infertility-testing/amh

In the past, we had to depend upon  FSH  levels. A high FSH level suggests poor ovarian reserve, but FSH levels are not very reliable, because they vary according to which day of the cycle the test is done; and can also be artificially suppressed by a high estradiol level.  AMH is a much better marker for ovarian reserve. It does not vary from cycle to cycle; and remains the same throughout the cycle.

A low AMH suggests you have poor ovarian reserve. You can read more about this at  http://www.drmalpani.com/knowledge-center/the-infertile-woman/oopause

Even if your level is low, this does not mean you should panic ! Remember that it's just a test - and good doctors do not treat tests - we treat patients !

Step number one is to repeat it again - preferably from another lab.

Step number two is to run an additional test to check your ovarian reserve. This is called an antral follicle count , and is done by doing a vaginal ultrasound scan on Day 3 of your cycle . You can read more this at http://www.drmalpani.com/knowledge-center/articles/afc

Even if these are poor, this does not mean you cannot improve it ! While Western medicine does not have much to offer, there are alternative medicine options you can try to improve your ovarian reserve

These include the following:

1. Yoga
2. Acupuncture
3. DHEA, 25mg thrice a day.
4. Vit D3 ( Calcipherol), 60000 IU, once a week for 10 weeks

Women have tried other supplements, such as Royal Jelly, MACA, Wheat germ and CoQ , but there's no proof that they help - this is all empiric therapy.

If you have not been trying for too long, do remember that young women with low AMH levels do also get pregnant on their own ( though their chances are reduced). After all, levels provide information about groups of women , and there can be a lot of individual variability !

IVF with aggressive superovulation would be your best option as it would maximize your chances of getting pregnant quickly and help you make the most of the eggs you have left. It allows us to telescope time for you. The problem however is that often poor quality eggs result in poor quality embryos,  which means that your chances of implantation are poor , and you need to be prepared to accept this bitter fact.

Plan B would to consider natural cycle IVF. Read more at www.drmalpani.com/knowledge-center/articles/natural-cycle-ivf

Plan C would be to use donor eggs, if you are willing to consider this option. This has a much higher success rate. Read more at http://www.donoreggs.in/

For heaven's sake, please do NOT allow your doctor to do surrogacy for you if you have a low AMH    level ! Surrogacy is an expensive and complex treatment option, which is best reserved for
women without a uterus, or whose uterus has been irreparably damaged. For women with a low AMH, the problem is with poor egg quality -  your uterus is usually perfectly normal . Transferring your embryos into another woman's uterus makes no sense at all , and will just waste your money !

You can read about more about how we take care of our patients at http://www.drmalpani.com/ivf-treatment-at-malpani-ivf-clinic.htm

You can talk to some of our patients by email at http://www.drmalpani.com/success-stories.htm

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 !

Doctor, what's your website url ?

It's well known that most patients will google their symptoms and signs when they fall ill. Patients use the internet extensively to research their disease; to check on the treatment options available to them; to connect with other patients; and to select the right doctor.

However, if there so many patients are online, why don't more Indian doctors have their own websites ? Indian doctors are considered to be well-read; well-informed; and their clinical skills are usually excellent. Moreover, India is an IT powerhouse , which means one would logically expect that most Indian doctors would have their own website, which they could use to attract more patients; and to educate their existing patients.

While many Indian doctors now do have their own email address ( though many senior doctors still do not use email; or get their secretary to read and write their emails for them), most still do not have their own website because they do not see the need for this.

Senior doctors who have a flourishing practise without a website are quite happy to continue coasting along on their reputation. They do not think a website will add any value to their practise , and are not interested in exploring this new platform. Some are suspicious of these new-fangled fads; while others will actively criticise doctors who have websites, because they feel they are a form of advertising - something which is below their dignity !

Other doctors understand the value of having their own website, but because they are not computer-savvy, they are not sure how to go about getting one. They are worried that having a website is a very expensive option - and are not willing to invest the time and energy in creating one. They'd rather continue muddling along in the fashion to which they are accustomed - and they are quite contented getting patients through kickbacks and referrals because they cannot think out of the box.

Many doctors are employed by corporate hospitals; and they feel that the corporate hospital website provides enough of an online presence for them. Some doctors have had an unhappy experience with website companies in the past. They have burned their fingers badly, and are no longer willing to trust computer professionals any more. Others have done a half-hearted job ( using free websites offered to them by pharma companies) ;and because these did not result in any tangible benefits, they have jumped to the wrong conclusion that it's not worth creating a website because not enough Indian patients are online.

This is a major error on their part. Internet penetration is increasing by leaps and bounds in India - especially with the introduction of 3GH services and inexpensive smartphones. Doctors who do not have their own website will start losing patients to doctors who are online - and this gap will increase progressively over time !

If you are in practise, you cannot afford to be left behind - and this is especially true of the younger generation of doctors, who need to establish their practise and attract patients.

Rule Number 1 for any successful doctor is - go to where the patients are ! In the past, the patients were in hospitals, which is why hospital attachments were so actively sought after. Today, it's a completely different world - and the best place to reach out to patients is the online world !

Clever companies such as Plus91 ( in which I am an angel investor) have realised that there is a huge opportunity for a startup in India which specialises in providing websites for doctors only. They have married technological expertise with medical knowledge, to create a great portfolio of websites for Indian doctors. Since this is their only niche, they have a lot of expertise and experience in this space, in which they have become market leaders ! They can set up a customised website for a doctor ( with your own domain name) within 3 days ! You can check out their work at www.websitefordoctors.in !

Doctors, patients, internet, information and wisdom

“What can you possibly learn from your doctor that is not available on the Internet?” We suspect we'll hear such radical sentiments increasingly in the future. Knowledge is said to be power, and some of the past imbalance of power between patient and doctor may be equalized. But information and knowledge do not equal wisdom, and it is too easy for nonexperts to take at face value statements made confidently by voices of authority. Physicians are in the best position to weigh information and advise patients, drawing on their understanding of available evidence as well as their training and experience. If anything, the wealth of information on the Internet will make such expertise and experience more essential. The doctor, in our view, will never be optional."

Actually, there are some things which the internet can teach patients far better than the doctor
can ! Youtube videos ( on how to take your IVF injections for example) can be played and replayed - and websites don't lose their patience with patients ! Also, many doctors are often not very good at teaching because they cannot stop using medical jargon.

Websites and doctors are all tools which a smart patient should have in their medical tool box. The real mark of a wise patient is that she knows which tool to use at which time !

Premature ejaculation , sexual self-esteem and infertility

Most infertile men have poor sexual self-esteem. As it is , they feel inadequate because they cannot get their wife pregnant. On top of this, if they cannot perform in the bedroom, this makes a bad situation even worse.

Sexual problems are as common in infertile men as they are in fertile men. Premature ejaculation is the commonest male sexual problem. It is very distressing , because it makes the man feel inadequate and inferior.

Read more at http://www.drmalpani.com/premature-ejaculation.htm

Why it's unethical for doctors not to have their own website

Many doctors are still worried that it's unethical to have a personal website.They feel that this amounts to advertising, and that a website is a way of soliciting patients.

I strongly disagree. In fact, I feel it's unethical for a doctor not to have their own website ! The word doctor is derived from the word, " docere", which means to teach. This clearly means that one of the key responsibilities of a doctor is to teach their patients. While many doctors do this face to face, the amount of teaching which can be done this way is very limited - and a conversation is not the best way of transmitting information.

Doctors who publish their own websites communicate with their patients online - and a website is a much more powerful tool of reaching out to thousands of people who are looking for information ! If the doctor wants to be sure his website is popular and gets lots of traffic, he needs to provide information on his website which is of value to patients, which means his website has to be full of patient educational content . Good doctor's websites are not all about the doctor - they are all about the patient !

A website allows a doctor to provide authentic , reliable updated information to patients. This information is local - and can be provided in the regional language ! Since it's provided by a trusted figure, patients are much more likely to trust this information.

Doctor's websites are a great way of reducing medical myths and misconceptions; and educating society at large !

Equally importantly, having a website forces a doctor to be transparent and honest. He cannot tell a lie on his website, as this will get him into serious trouble. This is good for patients - and doctors as well ! It also teaches the doctor to be much more patient-centric as he has to use simple words which his patients can understand when talking to them online !

If I were the Health Minister of India, the first thing I would do would be to make sure every doctor had their own website. This would create a win-win situation, which would help both doctors and patients !

Happy Couple from Canada

Hi, We are from Canada and this is our short story that we would like to share as noted below:

First of all, would like to extend our warm gratitude to Dr.Aniruddha & Dr.Anjali Malpani, and your staff making our IVF treatment a SUCCESS !!!
I am on the eleventh week of pregnancy now and hoping and always pray it will be a SUCCESS until the baby is born.

Planning/deciding to undergo IVF is not a joke/easy. There are a lot of things to consider.

1. Financial - IVF involves a huge amount of money like travelling expenses, hotel,food,medicine and might affect the job as well
2. Stress - Need to manage your stress - IVF involves a lot of stress.
3. Taking the risk

a. Job - Ready to quit the job to have full rest if required according to case to case basis before and after the treatment until the baby is born
b. Effort - Regardless how much effort you exerted expect that sometimes it doesn't succeed at one time treatment only.
c. Time - Ready to accept that in first/second try did not go thru.
d. Budget - It might be very tight at times especially if income is limited.

4. Health - It is very important to remain healthy like balance diet, avoiding caffeine,/alcohol/smoking and have a daily exercise with the doctor's guidance according to health conditions.

I am now in my first pregnancy which is my third IVF treatment with Dr.Malpani coming from Canada to India 3 times. It was really hard to travel and adjustments to another country and lot of stress and finance involved. We cannot fight with God's creations or the nature but the doctors can help to make it happen.

We are really lucky to find the right clinic with experienced doctors who are always there to help, and taking extra steps to make the IVF treatment a success and its so fantastic to have a doctor who responding to all our inquiries promptly all the time additionally his staffs are all helpful and very co-operative treating us like a family and clinic has an excellent facilities everything is done in the clinic itself no need to go somewhere else which is very convenient for us, being a patient for 3 times there we know everything. and enjoyed as well. There are lots of good things to tell but there is no words to express...

However, just to let you know that there are still lot of trauma during my pregnancy on 6th to seventh week had 3 times heavy bleeding but this did not lost our hope I have to deal with and relax thank god did not happen again and very soon I am going to finish my first trimester by April 16,2011.

Thank God !!! There is really nothing impossible. First of all trust in God, trust your doctors, trust yourselves, take a risk and go for it!!!

[email protected]

Why am I not getting pregnant doctor ?

I just attended a seminar for gynecologists. One of the sessions consisted of a moderator who described the medical details of a series of infertile couples and then asked the panelists how they would treat them in their clinic.

Read more at http://www.drmalpani.com/why-am-i-not-getting-pregnant-doctor.htm

Dr Malpani on Twitter !

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