How to make the right decision - a guide for infertile couples

Infertile couples have to make many decisions . Should they do IVF ?  How do they select the right clinic ? How many IVF cycles should they do ? Should they consider using donor eggs ? or adoption ? When should they call it a day ?

These can be difficult decisions to make , partly because they have incomplete information ; the outcome is always uncertain; and because they are very emotionally charged issues.

Here are 7 strategies , developed by neurobioogists, to help you make the right decision

1. Decide on a research strategy - and then set boundaries . For example, let's say you want to find the best IVF clinic. You can use the internet ; or ask your friends ; or trust your doctor to refer you to the right clinic. Please remember that these are not mutually exclusive options. They can be complementary , and you can use them together to create a short list of doctors to interview.

2. Limit your options . The paradox of choice goes like this : we think that the bigger the choice the better our decision. In fact , with too many choices, we spend too much time weighing up the options , so that at the end we may not reach a decision at all. Make sure you do not get trapped in the phenomenon of " paralysis by analysis ".

3.. Accept good enough . This is called satisficing. Decide on something that meets your basic requirements , instead of searching for " the best ". For example , if you're looking for an egg donor , and you find one who meets your requirements , don't waste time trying to shop around , looking for someone who is better. This only leads to unhappiness .

4. Don't fear the consequences. The consequences of most decisions are not as long-lasting as we think , says Dr. Daniel Gilbert . In the scheme of things , every decision loses its importance , with the passage of time . The wisest words known to man are - " This too will pass".

5. Go with your gut instinct . Research has shown that there seems to be a part of us that knows more than we think we know ; and we do tend to be more forgiving of wrong decisions made intuitively , rather than once we spent a long time thinking about . It's easier to forgive our heart as compared to our head.

6. Have someone else choose. We tend to think that we are happy if we take things into our own hands . However , sometimes the opposite is true ! When we are forced to make our own decisions , we suffer nagging doubts that we didn't make the best choice. However if you trust your doctor , you can allow him to decide for you . You will be happy if the outcome is good; and if the outcome is bad, you then have someone else to blame !

7. Once you have decided , then don't question your decision anymore.

If you follow these steps, the chances of your making the right decision improve considerably.

However, if you are still not sure what to do , inspite of agonising for weeks on end, here's a very simple method, discovered by Ignatius Loyola , for making the right decision . For example, suppose you've failed 3 IVF cycles and you then need to decide if you should do a fourth IVF cycle, or just call it quits and live child-free. Both these are difficult options, and it can be hard to decide which one is right. First , spend three days as if you had made a decision to go for another cycle. During these three days , make a note of all your thoughts , feelings and dreams . Then , go through the same process , with the alternative decision - that of living child-free. Compare notes at the end of this time - and then decide. This way, you'll be able to listen clearly to what your heart desires !

Need help in making the right decision ?

Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

VC Circle Health conference

I attended the VCCircle Health Conference 2013 held in Mumbai.

As you can see from the photo, the hall was packed - there were over 200 people attending.

I enjoyed the conference, because there was a great mix of entrepreneurs; funders; and consultants.
The sessions were well organised - and the conference ran on time, which is always such a refreshing change in India !

I liked the fact that the individual speakers did not make presentations. The format was a Q and A session with a moderator - and because the organisers did a good job with selecting their speakers and their moderators, the conference was fun  !

I met a lot of interesting people - and healthcare seems to be a hot area to invest in right now !

The 2ww prayer for IVF patients

To take one day at a time

To refrain from obsessing about each twinge and ache I experience in my body

To be kind to myself

To enjoy the wondrous mystery of the 2ww

To understand the difference between healthy hope and unhealthy expectation

To accept success and failure as if they are one and the same

To preserve my original self amidst all this craziness

To abstain from hurting others during my stressful times

To hide my pain and wear a smile on my lips always …

To use my pain to grow even better without getting bitter

To stay positive so that my loved ones remain happy and tranquil

To be serene amidst all the uncertainity

To be grateful for the blessings I possess

To understand life is not all about winning but about trying

To accept that life can be very unfair at times

To realize that many others have to bear much more pain than I have to

To love and appreciate life even more ...

To hold on to hope , yet have the wisdom to know when to quit

To trust that whatever the outcome, I will emerge a stronger and a better person

To gain the ability to achieve peace of mind that I did my best

And .....

If the pregnancy test turns out to be negative ...

Let me have the

Serenity to accept the outcome

Courage to pick myself up and keep going

To bear the disappointment in my partner’s face

Intelligent to gain insight from my failure and wisdom to not let the failure go to my heart

And .....

If the pregnancy test turns out to be positive ...

Let me have the

Goodness to accept my blessing with humility

To hope for the best yet be prepared for the worst

And to continue to live life with utmost gratitude

This is an excerpt from our forthcoming, book, The Expert Patient's Guide to IVF. This being authored by our expert patient, Manju and me.

 You can email Manju at [email protected]

Her blog is at www.myselfishgenes.blogspot.com

Dr Hemant Morparia to speak at the HELP conference on Patient Advocacy !

Dr Hemant Morparia , the famous cartoonist, has kindly agreed to give a talk at the HELP conference on Patient Advocacy ! He will be talking on The Lighter Side of Patient Advocacy , using his cartoons.

Dr Morparia is one of the most colourful doctors I know. He graduated from Seth GS Medical college and KEM Hospital, Mumbai with a post-graduation in Radio-diagnosis MD . He was a lecturer at the mumbai university for 3 years. He started cartooning while doing a residency in the hospital, which means he has been cartooning for more years than have been practising radiology. He has a wicked sense of humour, and has published more than 12,000 cartoons. He draws inspiration from a range of topics- politics, urban issues, science, medicine, sports,and spirituality.

He has been the daily cartoonist for Mid-day for 6 years now. He has also published books of cartoons- 'Fanatics and their antics', 'Say Hah!' (medical cartoons) , 'Never again', 'Pyar ke side-effects' (cartoons on love,sex and dating); and has had four cartoons exhibitions till date in mumbai . at the National Gallery of Modern Art 2002, Mumbai, Sakshi Gallery,2004 and the Alliance Francaise , 2009 and 2010.

Our 4th Annual Putting Patients First conference  will be held on 16 Nov, Nehru Center, Worli. Darius Khambatta, Advocate General, Maharashtra, will be Chief Guest and KeyNote Speaker; and we will be releasing our book – Patient Advocacy – Giving Voice to Patients, at this time

You can register for the conference free at www.patientpower.in !

Dr Devdutt Pattanaik to speak at the HELP conference on Patient Advocacy !

 Dr Devdutt Pattanaik has kindly agreed to give a talk on -  Patients and Doctors in Indian Mythology – what we can learn from them !

Dr Devdutt is well-known for his "out of the box" approach for dealing with topical problems. He is the author of Business Sutra: a very Indian approach to management, where he says "Belief shapes behaviour and behaviour shapes business."

Trained as a medical doctor, he worked for 14 years in the pharma and healthcare industry for 15 years before becoming business advisor in Ernst & Young. He then turned his hobby and passion into his profession to become Chief Belief Officer of Big Bazaar Future Group.

He is author of 25 books, 400 articles on relevance of mythology in modern times including Jaya : an illustrated retelling of the Mahabharata . He consults Star TV and Epic TV on storytelling. He is advisor to the shows Devon ke Dev Mahadev as well as Mahabharat.

His radical yet accessible views on leadership, management, governance on TV shows like Shaastrath on CNBC Awaaz and Business Sutra on CNBC have made him a popular speaker in corporates and lecturer in business schools.

Our 4th Annual Putting Patients First conference  will be held on 16 Nov, Nehru Center, Worli. Darius Khambatta, Advocate General, Maharashtra, will be Chief Guest and KeyNote Speaker; and we will be releasing our book – Patient Advocacy – Giving Voice to Patients, at this time

You can register for the conference free at www.patientpower.in !

The Laws Of Medicine: What Every IVF Patient Should Know

Several years ago, Dr Vernon Coleman, who qualified as a doctor in the UK, published an outstanding series of books on wellness and health. Mentioned below are his laws of medicine, as applied to IVF.

Coleman’s 2^nd law of medicine

Do not perform tests if the results will not affect your treatment.

Infertility doctors are very fond of ordering tests and many patients naively believe that the number of tests the doctor orders correlates with how thorough and careful he is – they feel that the number of tests ordered is proportional to the doctor’s competence !  Sadly, many of these tests are useless.

A corollary of this is

Coleman’s 4^th law of medicine

“ Routine “ diagnostic tests ( such as hysteroscopy and laparoscopy) are more profitable for doctors as compared to patients. They rarely change the treatment options which the doctor can offer you – and the same information can be provided as effectively with the help on non-invasive tests ( such as HSG and ultrasound scanning) which are much safer and less expensive.

Coleman’s 7^th law of medicine

IVF too has its own share of fashion and trends , just like clothes do. 

These include: testing for NK cells; 

treating with lymphocyte immunizations; 

IVIG infusions; and 

PCR testing for TB.   

However, fashion blunders in clothes might just end up embarrassing  you , but fashionable blunders in IVF can be painful and expensive.

Worried that you are becoming a victim of Coleman’s laws of medicine ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Victim blaming, stress and IVF failure

While infertility and IVF abound with misconceptions and old wife’s tales,  the number of myths about stress and IVF far outnumber those in any other area of reproductive medicine. For every failed IVF cycle, people have made the patient’s stress an easy target to blame. This is why  mind-body courses that teach patients to manage stress are becoming so popular.

Patients naively expect to get pregnant when the IVF cycle goes smoothly and the doctor transfers good quality embryos into a perfect uterine lining . During the transfer procedure, doctors are also usually upbeat and optimistic , so they can cheer up the patient. When the IVF cycle fails, this comes as a rude shock. The patient’s relatives often heartlessly blame the patient for the failure, claiming that it was because the patient was too stressed out, that her body did not accept the embryos.  This is why so many family members force the patient to sleep in bed during the 2 ww. They believe that this causes the patient to relax , and will improve the chances of success.

Unfortunately, a lot of patients believe in this flawed, reasoning because it’s not possible to prove that it is wrong. Also the failure of the procedure has a negative impact on their self esteem. Hence, these women usually blame themselves because their embryos didn’t implant. I personally feel this is an unkind form of victim blaming. 

The reality is that every IVF patient is stressed – after all, no one enjoys going to an IVF clinic . If stress was to cause an IVF cycle to fail, then there wouldn’t be any IVF success stories at all  ! Embryo implantation is a biological procedure that has nothing to do with stress. After all, rape victims can and do get pregnant, no matter how much stress they are under !

Do you need help in coping with your stress levels during IVF treatment ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

The fertility of older women

 

 Many of the patients who come to our IVF clinic are older couples who have married in the recent past. The wife’s age is typically above 35 and the husband is above 40 years of age. Most of these couples are dynamic career oriented professionals who are very busy due to their work commitments and have only little time for their personal life. For many of them, getting married was a low priority in their life.  However, once they have found the right spouse ( thanks to help from  matrimonial websites or family or friends), after getting married , they have to decide whether they want to have kids or not. 

When they start thinking about this, many older women realize that their biological clock has ticked on, which means it won’t be as easy for them to conceive as compared to younger couples. For most women, this is a sudden wakeup call . They are very used to being successful in their careers and life , and they usually have managed to achieve what they desire. These women also naturally assume that now that they have found their prince charming, they will be able to naturally progress to the next level of having their own kids - and that this will fall into places as naturally as all their career successes have.  After all, they just need to work at it to get what they want ! However, when they find out that their eggs are not in the best form to allow them to have a baby, this  comes as a rude shock , which they aren’t prepared for. 

The surprising part is that many of these women have a strong desire to become a mother . This lust for babies is a very powerful craving , which is why they seek medical help. These women are usually the ones who don’t think about have kids when they were younger. But as their biological clock passes by, the urge to become a mother becomes an obsession for them. 

For IVF doctors, these patients are very satisfying to deal with, because these couples are well-informed and educated .  They are understanding and mature, and because they have faced a lot in life , they are able to make the right decisions for themselves.

For an interesting debate about the pros and cons of older women having babies, please read the debate pn the New York magazine article at http://bitchmagazine.org/post/bringing-up-baby-motherhood-as-the-dream-deferred
 

Worried that your biological clock has left you behind and that your eggs are too old ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !