Top surrogacy clinics under MMC scanner

Three of the city's top surrogacy clinics are under the scanner after Police Commissioner Rakesh Maria recently raised a red flag over possible visa norms violations by them.

http://www.mumbaimirror.com/mumbai/cover-story/Top-surrogacy-clinics-under-MMC-scanner/articleshow/34343859.cms

This is why it's so important for patients to be sure they choose an ethical and reputable IVF clinic for their surrogacy  treatment. While the embryo transfer is very easy to do , it's equally important that the legal procedure laid down by the Government of India be followed properly. Taking tempting shortcuts ( for example, by not signing the proper legal contracts) can result in disaster !

Why I encourage my patients to interpret their own medical reports !

At Malpani Infertility Clinic we ensure that our patients are actively involved in every aspect of their treatment.  In the course of formulating a treatment plan, we need to order medical tests ,so we can judge the quality of the eggs and sperms , and use this information to plan further treatment. When patients come back with their reports, I make it a point to ask them what their opinion about the reports is . I want to understand what they have understood from their reports !

This process can be confusing for many patients.  Isn’t it the doctor’s job to explain the reports to the patients?  Yes! It sure is. My unique approach towards the report interpretation is a part of our patient education program.  It helps me to audit how well our patients understand what we are doing for them.

When I quiz my patients about their reports or treatment, they make sure they do their homework before their next visit. Our patients start to take an active interest in their medical management. This benefits them as well as me and my staff. When my patient is aware of what is happening, the staff at Malpani clinic is on their toes at every juncture. The patient is treated with respect and utmost care.

Often patients are afraid to question their doctor , or to ask him to explain the meaning of complex medical jargon. When I question them, I get to know their level of understanding and thus can improve my patient education skills .

A major benefit of improving patient awareness is that it helps to reduce medical errors.  It also ensures that patients have realistic expectations of their treatment, and are in control of their life.  Our patients appreciate the fact that we spend so much time in partnering with them !

We do not believe in confusing the patient by spewing medical jargon and using complex polysyllabic medical terms which are designed to go over the patient’s head , so as to intimidate them.  An active two way approach helps strengthen the doctor-patient relationship , and allows us to deliver the best IVF treatment.

Do you need help in interpreting your medical reports ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly!

Why are infertile women willing to acts as guinea pigs ?

I see lots of patients who have had numerous unproven experimental treatments, such as IV immunoglobulins, hysteroscopic metroplasty and immune therapy with paternal lymphocyte immunization.

I sometimes wonder why patients are willing to subject themselves to these treatments . They are expensive , have risks, and have never been proven to actually improve pregnancy rates .

Now I can understand why doctors want to push these treatments. They can charge a lot more of them, because they can sell these options as being “the latest, cutting edge technology”.  Doctors enjoy playing the game of one upmanship. They want to offer stuff which is new, because they want to show patients they are better than the other doctors !

The danger is that when patients sign up for these treatments, doctors are not frank and forthright in telling them that these treatments are still being tested and have not been clinically proven to be effective. The doctor frames these treatments as being “ state-of-the-art “ , and that they can do stuff which other doctors cannot !

It’s quite easy for doctors to take patients for a ride. They are often naïve and emotionally vulnerable. They are happy to trust their doctor. After all, the very fact that they have selected this doctor means they think he is the best !  Because most patients don’t bother to do their homework or invest in information therapy , they are easy to dupe. This is especially true when they have failed multiple IVF cycles . They are quite happy to sign up for whatever the doctor suggests.

Now while it’s fine to offer these new options in a controlled clinical trial setting , it’s not fair to do this by pretending to the patient that these treatments improve pregnancy rates. Sadly, doctors will not even bother to document the results of their interventions, and will continue tom-tomming their anecdotal successes to prove that their treatment works.

Patients need to insist that doctors practice evidence-based medicine . The truth is that it takes time for medicine to find the truth. Newer technology does not always improve success rates – and it can often harm the patient, because of the “learning curve” associated with anything which is new. The treatment intervention has to be repeated many times and we have to analyse the experience of many clinics , before we can judge whether or not a particular treatment is actually clinically beneficial or not.

Doctors can be very good at “selling” these treatments to their patients. They are happy to charge more for them, which means patients are actually paying for the “privilege” of being guinea pigs. Doctors wax eloquent about the difficult cases they have treated successfully with the gizmo – and patients are not sophisticated enough to cross-question their doctor, or read between the lines.

The medical device industry is very happy to promote these gadgets , and few doctors are willing to listen to the voice of reason in the clamour and excitement to be the “first” to offer the newest technology. The media also helps to make a bad situation worse, by uncritically promoting and reporting the “new” treatment as being “news”.

Patients are often fascinated by what is new, because they naively believe that “new is better”. However, this is not always true in medicine , where older, time-tested and proven techniques are often the better and safer option.

Ignorance is more dangerous than "half-knowledge" for infertile couples

Many infertile women spend a lot of time on the net , doing research in order to find out more about IVF. They are willing to invest their energy in learning more about IVF, because they want to maximize their chances of having a baby. Many of them are frustrated by IVF doctors who refuse to talk to them, or explain what is happening, and they wart to regain control of their life.

However , rather than admiring their persistence and their desire to learn more , a lot of husbands and family members can be quite critical their online activities. They often say cruel statements, such as “ Don't try to become a doctor” or “half knowledge is dangerous “.

This is completely wrong ! These women are highly motivated , and want to learn more about IVF, so that they can become better informed about their IVF treatment . We should encourage them in their quest for information , so that they have realistic expectations of the treatment , and can have an intelligent discussion with their IVF doctor.

There are many IVF treatment options available today, and patients are often confused. Doing their research will allow them to formulate their own course of action and select the best IVF clinic , so they have peace of mind they did their best.

Good IVF doctors respect patients who are well informed and who are clear about their goals. These patients don’t get upset if the cycle fails, and are much better able to cope with the IVF emotional roller coaster ride. Good IVF clinics will create educational resources, to help patients learn more, so they can form a partnrship with their doctor.

It’s true that these patients can be quite demanding . They have lots of questions , and are not willing to just passively accept what the doctor says as being gospel truth . They are willing to push back ; to be assertive; and to explore alternatives and options .

In fact, some of the smart ones will often know even more about a particular topic that the doctor does. ! This is why some IVF doctors feel threatened by these patients. They will often try to assert their authority and put these upstart patients in their place by being rude or using medical jargon.

Yes, it’s true that not all websites are reliable and that there’s a lot of junk online. However, this does not mean that patients should not explore the internet at all. Just because there are a few bad sites does not mean they should not take advantage of the wealth of reliable information available on the good websites !

It's far better to have a little knowledge , rather than know nothing at all. If you are completely clueless, it’s easy for a bad IVF doctor to take you for a ride ! And once you have been cheated by a bad doctor, you will never be willing to trust another doctor again.

While it’s true that you don’t need to learn how to do IVF yourself, it’s also equally true that you need to learn to become an expert patient if you want to maximize your chances of success !

Complaints, compliments and patient reviews about Malpani Infertility Clinic

Free patient education app for android tablets from HELP

DocExplain is a free app doctors can download from the Google Play Store at
https://play.google.com/store/apps/details?id=com.olicious.docexplain

Docexplain helps you to teach your patients.  A picture is worth a thousand words – and our app has a library of over 200 ready to use images, which cover all body systems and specialties.

You can :

• Edit and customize these images

• Create and add your own images ( for example,  images from the net; photos of operations ; and X-rays)

• Share them with patients and colleagues

Embryos and babies are not the same

Good quality embryos are an integral part of a successful IVF cycle. When patients get to see their embryos, they start getting emotionally attached to them. Their embryos symbolize a successful step towards child bearing for them. The embryos are a result of the right treatment combined with modern technology. When the infertility specialist transfers the embryos to the patient’s uterus, many patients start referring to their embryos as their babies. Many start feeling that they are just a few days away from a positive pregnancy test. Unfortunately , this is not true , and not all transferred embryos will implant. Not all embryos become babies.

The clinical procedure until the transfer of the embryos can be controlled. However , after the embryo transfer , it is impossible to predict what will happen inside the uterus. Implantation is a biological process, and involves the complex cross talk between the molecules produced by the embryo and the endometrium. It is beyond medical control .

We know from genetic analysis that most embryos fail to implant because they have intrinsic genetic defects. Research shows that over 90% of embryos from women over 40 years of age are aneuploid
( genetically abnormal, because of an abnormal number of chromosomes) . This is why they fail to implant. This is Nature's defense mechanism, to prevent the birth of an abnormal baby. This is why the pregnancy rate even with surrogacy for older women is so poor.

Today's technology is still limited, and lots of these defects still cannot be accurately diagnosed.  Human reproduction is inefficient and patients need to come to terms with this.

Need help in making sense of a failed IVF cycle ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

What patients have top say about Malpani Infertility Clinic

Is Adoption a good solution for infertile patients?

Most fertile couples are blissfully unaware of what infertile couples have to go through in order to have a baby. They are not aware of the suffering which infertility causes; and have  no clue about the treatment options available for infertile couples.

They will often be flippant about infertility  - and will often provide “advise” to infertile couples which can be heartbreaking. While they may not mean to be cruel, their insensitivity can cause a lot of pain and heartbreak.

Thus, many people advise infertile couples to just adopt a baby. They say stuff like – Isn’t this a much better and kinder thing to do , rather than take painful injections ? After all, what could be nobler than provided an unwanted baby with a loving home ? If I didn’t have children of my own, I would definitely have adopted a baby, rather than go to an IVF doctor !

Many people naively believe that the process of adoption is as easy as picking up a beggar child off the street and taking him home. They do not know what a complex process adoption can be – and how long the waiting lists are.

In reality, the number of children who are being put up for adoption is going down dramatically every year. This is because the number of unwanted children is on a sharp decline due advances in contraceptive treatment. Most women who find they have an unwanted pregnancy choose to safely terminate the pregnancy , rather than continue with it. The children we see begging on the streets are not up for adoption ! They are economic assets to their families , rather than being unwanted because they earn money for their families by begging, selling newspapers or used plastic bags. As a result the adoption agencies have a long waiting list of infertile couples.

The adoption decision involves intense soul searching by the couple , along with the whole hearted support of the relatives. If the couple chooses not to adopt , please respect their decision and appreciate that they have invested a lot of thought into this !

The good news is that even though adoption a baby has become increasingly difficult, it’s now possible for infertile couples to complete their family using the process of embryo adoption ! Not only is this much less expensive than traditional adoption, there’s no waiting list involved either. Even better, since the woman carries the pregnancy herself, she can experience the joy of
motherhood !

Confused as to whether IVF or adoption is the best choice for you ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Freeze your eggs ! Bloomberg cover story

Not since the birth control pill has a medical technology had such potential to change family and career planning. The average age of women who freeze their eggs is about 37, down from 39 only two years ago. (“Desperation level,” as Brigitte Adams, a marketing director at a Los Angeles software company who froze her eggs at 39, puts it.) And fertility doctors report that more women in their early 30s are coming in for the procedure. Not only do younger women have healthier eggs, they also have more time before they have to use them.

http://www.businessweek.com/articles/2014-04-17/new-egg-freezing-technology-eases-womens-career-family-angst#p4

The good news is that instead of spending the US $ 10000 which US clinics charge, you can freeze your eggs at Malpani Infertility Clinic for a fraction of that cost !

What to learn more about egg freezing ?

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

My experience at Malpani Infertility Clinic

I have done 3 IVFs with a leading IVF clinic in south Mumbai ( with Dr X ) and 1 with Dr. Anjali & Aniruddha Malpani. Dr. Malpani is without a doubt the place to go for your IVF treatment.

Here's a comparison of my personal experience with both doctors.

1. Dr. X's clinic felt more like a Mumbai local train, where hoards of patients jump on and jump off. We would end up waiting at her clinic for hours, for a simple 5 minute ultrasound procedure or an extremely brief consultation with the doctor. The experience at Dr. Malpani's clinic was the exact opposite. Their administration was so effective that we would hardly have a few minutes wait, and the personal time with the doctors was way above our expectation. Dr. Mrs. & Mr. Malpani each gave us a lot of personal attention, advice and face time. We were able to comfortably put forth all our queries, and they answered each and every one of them to our satisfaction.

2. At Dr. X's clinic, we were never really given proper information about the IVF protocol being used. Her staff would incompetently rush us through it. There was always this sense of someone waiting in line behind you, so they have to rush through everything. At Dr. Malpani's clinic, the doctors personally explain the entire protocol, the reason why they are choosing to opt for it, and
will gladly answer all your questions. They believe is knowledge is power, and will give you a very clear picture of what to expect.

3. While this is not related to the actual IVF process, you can expect to drive around for an hour to find parking around Dr. X's clinic, then wait in a long line for the elevator, finally followed by hours of wait (pretty much half the day) to meet with the doctor for a brief 5 minutes. This tremendously builds to the frustration of already going through an IVF cycle. Once again, the experience at Dr. Malpani's clinic is the exact opposite. We never had trouble finding a parking spot, there is no waiting for the elevator and most importantly, the wait to meet with the doctors is hardly a few minutes. And once you are in front of them, you can take your time asking all the questions, and they answer them with a smile. When you are in front of either Dr. Anjali or Aniruddha Malpani, their entire attention is with you, and they do not rush you through the personal meetings. To me, this was extremely comforting.

4. Now, here's a shocker!! During my 3rd IVF cycle with Dr. X, she forgot the day of my embryo transfer. I had gone through all those heavy medications, starved the entire day to prepare for the transfer, and when we arrived at her clinic for the appointment, she was on her way out for some
other appointment. As a result, she had to rush through my transfer. Right then I knew this was going to be a failed IVF attempt. The experience at Dr. Malpani was very different. Their staff calls you in a timely manner, reminding you of the embryo transfer appointment, and once again runs you through the preparation required prior to the transfer. Kudos to the staff as well.

5. At Dr. X clinic, we never got to see our embryos, not even a picture of them. They did not even bother to inform us of the embryo grades. At Dr. Malpani's clinic, we were personally shown owe embryos, given a picture of them, and informed that they were all grade A embryos.

6. Dr. X keeps sending you across Mumbai to get your blood test done at a specific clinic and to a medical shop in Central Mumbai to collect your injections. Clearly, there is a kick back involved. Going to various places for these tests and medicines added to our frustration and inconvenience. Dr.
Malpani, on the other hand, is a one stop shop. You get all the medicines at his clinic, and they even do the blood collection right at their clinic.

7. At Dr. X's clinic, they do not believe in maintaining the dignity of a woman. The ultrasounds and embryo transfers are done with a dozen other girls/women waiting in line (and male attendants around), with a flimsy curtain used for privacy that hardly covers the room. The discomfort is beyond
imagination. Dr. Anjali Malpani is very strict about ensuring that the woman feels comfortable during all these procedures, and her privacy/dignity is given utmost importance.

8. During the entire IVF process with Dr. X, we hardly interacted with her for a few brief minutes. As a result, we could not connect with her at a personal level, something I feel is important to do when going through such an important procedure in your life. Dr. Anjali & Aniruddha Malpani effortlessly
connected with me at a personal level, and that made me feel so comfortable through the IVF process. The positivity that they convey is highly commendable, and this trickles down to their staff as well. Nurse Lizzy and Pramodini were all a pleasure to interact with. Together, they ensured that my stress levels were in control.

The above is my personal (first hand) experience. If you wish to personally contact me, please feel free to send me an email to [email protected]. My name is Reema Sharma and I will be more than happy to answer your queries, even share my IVF reports from both clinics.

Wish all you ladies a successful IVF. And for all the husbands reading this, please bear with your women, they are going through a lot :)

Cheers,
Reema

[email protected]

Avaz Raises $550K In Seed To Help Autistic Children Communicate Using Visual Tools

As a member of Mumbai Angels, I am very pleased to be on the Board of Avaz , which has  just raised US 550K  . Avaz helps autistic children to communicate using an iPad app. Ajit is one of the smartest and most driven entrepreneurs I have met, and I hope to learn a lot on this journey !

http://techcrunch.com/2014/04/21/avaz-raises-550k-in-seed-to-help-autistic-children-communicate-using-visual-tools/

The smoke and mirrors behind HLA matching and NK cells activity assay – the “reason” and “cure” for unexplained implantation failure!

This is a guest post from our expert patient, Manju. She is a scientist, and this post will help you to debunk some of the myths and misconceptions surrounding "immunological implantation dysfunction". This is a complex topic, which most IVF specialists don't understand either ! She has a knack for simplifying complex issues and using intelligent metaphors !

I was recently reading a blog post from Dr.Sher.  He discusses immunological implantation dysfunction and claims that it is a common cause of repeated, “unexplained” implantation failure. He says that due to immunological dysfunction the embryo will be destroyed by “malfunctional” NK cells and hence implantation failure ensues. He assures patients that such ruthless “killing” of your precious embryos by “crazy” NK cells can be prevented by some specific therapies.  I was startled to see the way that article is written without any sound scientific basis – a nicely concocted story without any evidence!

The link for that article is here: http://haveababy.com/fertility-information/ivf-authority/unexplained-infertility-and-ivf-failure

Before reading it, you must understand the meaning of two different words which are used frequently in that article – HLA and NK cells. HLA stands for Human Leucocyte Antigen. These are molecules which are present on the surface of almost all the cells of our body and help to protect us against infections.  They are also known as the major histocompatibility complex (MHC) . When our cells are infected by harmful microorganisms, their antigens are loaded on to the cell’s HLA molecules. These HLA molecules then carry the viral or bacterial fragments to the cell’s surface. Once they come to the surface of the cell, they present the microbial fragments to our body’s immune cells called cytotoxic T cells.  Cytotoxic T cells constantly scrutinize our body for foreign antigens (microbial fragments or any other protein which are not normally present in our body). They can recognize these foreign microbial fragments only when they are presented to them by the body’s own  HLA molecules. Once the cytotoxic T cells recognize that a particular cell is infected by a microorganism , it kills the cell , thus protecting our body from harmful microbes. Consider this analogy :  a thief (microbe) enters your home (cell). You need to tell the policemen (cytotocxic T cells) who are on surveillance duty that a thief is in your home. When the thief is not watching, you send one of your servants ( the HLA molecule) with information on a piece of paper (microbial fragment) outside your home , so that the police men gets notified about the thief and can protect you. This is the exact scenario but with a minute difference-our body’s policemen (cytotoxic T cells) destroy (sacrifice) the infected cell to save the nearby healthy cells – they burn the house down to kill the thief !

In order to evade our intelligent immune system some microbes prevent the HLA molecules from carrying the microbial fragments to the surface of the cell. This is analogous to the thief who prevents the servant from going out of the house with the piece of information about the thief. In such circumstances , Natural Killer (NK) cells come to the rescue. When an NK cell recognizes that a particular cell doesn’t express enough MHC molecules on its surface as it should, it just destroys the cell by suspecting a possible invasion. Amazing , right ?

In short,  HLA molecules and NK cells are components of our immune system which help to protect us against microbial invasion and other insults.  If this is so, how they are connected to implantation failure?

Our immune cells attack not only cells that express microbial antigens but all cells that express non-self antigens (proteins that are not normally present in our body). This is why transplanted organs from a non-compatible donor are attacked by our immune system , and this is why they are rejected. A donor is said to be compatible if he/she carries identical HLA molecules as that of the recipient. If the donor’s organ express non-identical HLA molecules , then cytotoxic T cells recognize these foreign HLA molecules and destroy the cells of the donated organ.  This is why HLA is also called Major Histocompatibility (Histo =tissue) Complex (MHC).  It is only after checking the HLA compatibility between the donor and the recipient that organ donations are performed.

If this is the case, how does a fetus which carries half of its genes from its father (and hence different HLA molecules on its cells’ surface) survive the maternal immune system attack? In order to explain this , a hypothesis was proposed: that the uterus is an immunologically privileged site, and for a fetus to be not rejected by the maternal immune system , it has to carry different HLA antigens on its surface , and this helps the maternal immune system to develop tolerance to the fetus. This is exactly the opposite of the organ transplantations scenario , where the donor and recipient’s HLAs should match. As a result , when husband and wife have excessive similarity in their HLA molecules ( a high degree of HLA matching) and suffer from infertility , they are treated with a variety of immune therapies , to try to stop the maternal immune system from rejecting the fetus!

In his post , Dr. Sher writes:
“We diagnose alloimmune ID ( immunological dysfunction) by testing the male and female partners for the degree of sharing of genetic markers , known as of as DQa and HLA. A sufficient degree of matching clinches the diagnosis. We also test the embryo recipient for Nka in an attempt to measure the relative severity of the problem. This is because once the NK cells in the uterine lining are activated and the cytokine balance is disrupted, the situation is grave and will remain so (or worsen) unless the NKa cells are medically deactivated (down-regulated) at least 1 week in advance of the embryo(s) reaching the uterus”.

He obviously loves medical jargon , and talks about DQa and HLA, in order to impress patients ( and doctors !) as to how well-informed and erudite he is . DQa is just one sub-class of HLA. HLA is divided into class I and class II. Class I consists of HLA A, B, C and also HLA E, F, G. Class II consists of HLA DP, DQ and DR. Now what is the connection between HLA and NK ( natural killer) cells? How does HLA compatibility between the partners triggers NK cell activity which kills the embryo ?

 I have no clue – and neither does he, but he cloaks his ignorance in a lot of medical gobbledygook.
I need to explain here some scientifically proven facts about HLA expression in the human embryo,  and human NK cells:

    The part of the human embryo which comes in contwith the maternal immune system is its trophoblast cells - more specifically , the external villus trophoblast (EVT).

    These EVTs do not express class II HLA molecules (DR, DQ, DB) at all. They do not express highly antigenic class I HLA molecules (HLA A, HLA B). The EVT cells only express HLA G, E and C.

    You must note that most of the HLA matching between you and your partner is done for HLA A, HLA B, HLA DQ.  Even if there is a high degree of matching between you and your partner for these molecules , this does not have any significance as regards your fertility, because of the simple fact that these molecules are not expressed at all in the cells of your embryos which come in contact with the maternal immune system!

    It was believed (but never proved!) that if partners carry similar HLA molecules, the maternal immune system develop toxic T cells that might destroy the embryo . However, there is no proof that T cells attack human embryo.

The NK cell is another tall tale. I will enlist some facts about human NK cells below:

    There are two types of NK cells: CD56 bright+ CD 16+ and CD56 dim+ CD16+. CD56 bright+ CD 16+ is the cell type predominantly present in the uterus.  This does not have significant cytotoxic activity.CD56 dim+ CD16+ is the NK cell type present in peripheral blood and has extensive cytotoxic activity.

    The NK cell activity assay is mostly performed with the NK cells collected from the peripheral blood of infertile women . The NK cells present in peripheral blood do not reflect anything about the NK cell activity in the uterus. In other words, tests performed on peripheral blood NK cells cannot be used to draw conclusions about the uterus NK cells ! This testing is completely flawed.

    NK cells activity assay is performed by measuring its ability to kill K562 cells. K562 cells are cancer cells , and they do not express the HLA molecules (HLA G, E and C.) that are expressed on the human embryo’s extravillous trophoblast. When K562 cells are scientifically manipulated to express HLA E or G, the  NK cells failed to kill the K562 cells!

    When human trophoblast cells are grown in vitro (in laboratory environment) they do not express the same HLA molecules which they express in vivo (in the uterus). Also, even NK cells in vitro do not kill trophoblast cells!

The above scientifically proven facts I have painstakingly collected from the scientific literature emphasize only one thing – HLA compatibility between you and your partner and/or NK cell “malfunction” cannot kill your embryos It is wise to avoid tests used to “diagnose” them and therapies intended to “treat” and “cure” them. I sincerely wish that infertility specialists don’t make the vulnerable and desperate infertile patients’ condition even worse by making a mountain out of a mole hill. When a doctor meets a patient who suffers from unexplained infertility or repeated implantation failure, it is much more honest and humane to say ‘I do not know’ than to sell them false hope.

I agree this is a vexed and vexatious issue. The purpose of this post is not to ruffle any feathers or upset reproductive immunologists ! We just hope that this post will help patients make sense of some of the "mumbo-jumbo" which obscures this area, so they can make well-informed decisions for themselves, by asking intelligent questions !

Please read these articles for detailed info on this subject:  http://www.drmalpani.com/articles/hla_sharing_between_partners

http://blog.drmalpani.com/2014/03/nk-cell-testing-ivf-failure.html

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

Choosing Wisely - A Guide for Patients Five Medical Facts You Need to Know About Hormone ( Endocrine) Disorders

We are seeing  a major epidemic of avoidable care today. Unnecessary tests and expensive treatments have become a major health hazard. What can  you do to protect yourself ?


An initiative of the ABIM Foundation, Choosing Wisely is focused on encouraging physicians and patients to talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.

Adapted from the Endocrine Society and American Association of Clinical Endocrinologists (www.endo-society.org and www.aace.com)

1. Adults with Type 2 diabetes do not need to perform multiple daily self-glucose checks . Once target blood sugar control has been achieved, there is little to be gained from repeated daily testing . Self-monitoring is beneficial only when you are learning and adjusting to a new form of therapy.

2. Doctors sometimes over-order a vitamin D (1,25-hydroxyvitamin D) blood test. It should not be done unless your doctor finds you have a high level of calcium (hypercalcemia) or decreased kidney function.

3. Another test doctors commonly over order is thyroid ultrasound. If there are no signs and symptoms of thyroid gland abnormality, thyroid ultrasound is a costly procedure and should not form part of a routine evaluation.

4. Thyroid profiling (a panel of blood tests, including total and free T3 levels, ordered to help diagnose thyroid disorders ), is not needed for prescribing the correct dose of levothyroxine ( T4) in hypothyroid patients . In most of these patients, a normal TSH ( Thyroid-Stimulating Hormone ) level is enough to confirm the correct dose of T4.

5. Don’t go for testosterone (male hormone) therapy unless there is evidence of testosterone deficiency in your body. Testosterone therapy has the potential to cause serious side effects. It is important to confirm the diagnosis of hormonal deficiency (hypogonadism) by doing blood tests before going in for hormonal replacement therapy.

Our IVF success story

My husband and I have turned 30 now and have been married for 5 years. As we stay in a joint family there was lots of pressure for having a baby since second year . As we tried naturally 2 years but things did not turned out as we had planned . Then we decided to consult doctors for our
problem . We went couple of big doctors in Mumbai and undergone many test but didn’t find any good chemistry with any of them . As one of our family members had been treated in Dr Malpani clinic successfully , we decided to consult Dr Malpani. We read the reviews about Dr Malpani and were very impressed with the amount of information on their website at www.drmalpani.com.

After meeting Dr Malpani , all my negative vibes about doctors turned positive . Dr Malpani explained and treated us so well that we never expected doctors could be so calm and patient and give so much time and answer all the questions. He cleared all the confusion and doubts and made us believe that we could also have a baby.

                I started with my cycle in Jan 2013 and with my first IUI got a positive beta HCG . We were very happy as the first cycle itself succeeded . However, I miscarried and I was shattered . I gathered my courage and went back to Dr. Malpani after 3 months. Dr. Malpani was kind and understood what state I was going through and made me win my confidence in myself again. After that, two IUI failed. Then he suggested me to step ahead and do IVF. I started my IVF in Jan 2014. The injections are no fun, but every time I met Dr. Malpani , he destressed me and helped me to accept whatever is happening  positively.

        The best part of Dr. Malpani is that he himself monitors and takes efforts for the patients . He ( and Dr Anjali ) do the scanning themselves. They understand the patient deeply and do not rely on reports of another doctor. He takes care and checks that  all the proper medicines and injections are taken and explains the whole procedure very gently and clears all doubts. I got pregnant in the very first IVF cycle done in Malpani Clinic. Now I'm 13 weeks pregnant and am very thankful & grateful to Dr. Aniruddha & Dr. Anjali Malpani, and their whole staff , who every time gave us blessings & well wishes. All the staff & nurses were very supportive during all the treatments & procedures.

        We are very glad that we took very wise decision and went to Dr.Malpani and followed his treatment. 

Deepak and Shweta Soniminde
09821921922/09322077818

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Five Medical Facts You Need to Know About Allergic Reactions - Choosing Wisely – A Guide for Patients

We are seeing  a major epidemic of avoidable care today. Unnecessary tests and expensive treatments have become a major health hazard. What can  you do to protect yourself ?

An initiative of the ABIM Foundation, Choosing Wisely is focused on encouraging physicians and patients to talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.

These are Five Medical Facts You Need to Know About Allergic Reactions, as adapted from the guidelines by the
American Academy of Allergy, Asthma and Immunology (www.aaaai.org)

1. Blood tests which check for antibodies (ImmunoglobulinG (IgG) and immunoglobulin E (IgE)) are of questionable value in diagnosing the source of an allergic reaction. They just add to your cost and may even lead to inappropriate diagnosis and treatment.

2. If you develop a sudden onset of sinusitis (acute sinusitis), CT scans are of little help because the condition is caused by a viral infection which usually resolves on its own in two weeks. Antibiotics are not needed to treat uncomplicated acute sinusitis because less than two percent of acute sinusitis is caused by bacterial infections.

3. If you have chronic urticaria, also known as hives, ( where an itchy rash appears for a week or more) diagnostic tests are not usually helpful as a definite cause will often not be found in most patients.

4. If you have recurrent infections, unless you do not respond to vaccines, replacement immunoglobulin therapy is of little use.

5. If you have asthma, you need to perform spirometry, which is a simple lung function (breathing) test. Doctors sometimes don’t bother to order this test, and often rely solely upon symptoms when diagnosing and managing asthma, but symptoms may be misleading. Spirometry is essential to confirm diagnosis, identifying disease severity and monitoring control, so please ask for this.

Why are doctors scared of internet positive patients ?

The Mumbai Mirror had an article, which talks about a survey, conducted across 27 cities including Mumbai, Pune, Delhi, Kolkata, Chennai, Bangalore, Hyderabad and Ahmedabad by Ipsos Healthcare and Ruder Finn, which revealed that " doctors have been struggling to deal with patients who use the internet to find out what ails them.

Making matters worse are hundreds of thousands of online forums where people discuss their ailments and symptoms, which often result in patients indulging in self-medication, and also end up arguing with doctors upon being told that their ailment is not even close to the worse diseases they had imagined, said majority of the 650 doctors who participated in the survey.

The doctors, including specialists and super specialists, termed people's increasing dependence on the internet to find medical cures and search for symptoms as a "major strain on the doctor-patient relationship".
http://www.mumbaimirror.com/mumbai/others/Doc-the-internet-says-I-have-cancer/articleshow/33791626.cms

This is a completely archaic attitude in  my opinion.

My take is completely different ! Most good doctors are very happy to talk to internet positive patients , because they are well-informed and have realistic expectations . Patients who have done their homework actually have a better doctor-patient relationship, because the doctor has to treat them an intelligent adults, who have an opinion about their own health and would like to decide their own treatment options, in partnership with their doctor !


We believe that patients are the largest untapped healthcare resource – and that Information Therapy – the right information at the right time for the right person – can be powerful medicine !

Information Therapy helps patients get better medical care by
Promoting SelfCare , and helping them to do as much for themselves as they can
Helping them with Evidence-Based Guidelines , so that they can ask for the right medical treatment that they need – no more and no less
Helping them with Veto Power, so they can say No to medical care they don’t need, thus preventing overtesting and unnecessary surgery .

How can we use technology to empower patients with Information Therapy , so that they can become expert and engaged patients ? This is a challenge and an opportunity for doctors. Doctors who learn to put patients first will thrive as healthcare evolves and becomes more patient-centric !

Rather than force patients to get information from unreliable websites, doctors need to learn to put up their own websites, where they can empower their patients with reliable information. Websites are a great way of educating patients, and doctors who do so will earn their patient's trust !

Pushing patients into doing expensive IVF treatments

I received an interesting e-mail from a patient .

She wrote., “ I am currently pursuing IVF/ICSI/PGD/PGS eSET. Doctor performed one 'Endometrial Function Test' which determined 'Exteme Glandular Developmental Arrest' (aka 'Glandular Stromal Dyssynchrony') Treatment consisted of 3 consecutive months of 3.75 mg Depot Lupron, inducing menopause. After first failed eSET FET, my doctor is now pushing for gestational surrogacy, citing the 'GDA' as the primary reason why I will never carry to term. I am suspicious.”

As you can see , this is obviously a sophisticated , well-informed patient , who's done her homework . She is taking treatment at a modern, sophisticated , well-equipped , world-famous, " brand name"  IVF clinic in the USA , where her doctor has advised her that she needs surrogacy in order to have a baby. Fortunately, this patient is smart enough to realize that this is not good advice , which is why she asked me for a second opinion .

I can imagine how many other patients this particular IVF clinic must be taking for a ride, by coining all sorts of unscientific terms using pseudoscientific tests, in order to scare the patient and upselling them into doing expensive treatments.

While we talk about “ endometrial function tests”, the truth is that the endometrium is an extremely dynamic organ . We can easily can help the endometrium to grow properly , and “ treat the dyssynchrony “ by using estrogens. However by using medical jargon , such as “ glandular developmental arrest “ ( terms which even I find hard to spell and pronounce ), any patient is going to get intimidated . The doctor has folled her into believing that she has an intractable problem,  and would therefore be willing to do whatever the doctor advises.

The tragedy is that most patients are not sophisticated enough to understand what the doctor is saying. Many doctors take undue advantage of this information asymmetry and push patients into doing inappropriate treatment , because it is financially much more profitable for them .

By advising surrogacy , the doctor can make four times as much money as he would by doing an IVF cycle . Patients are often desperate and are happy to do what the doctor suggests. Similarly , lots of doctors suggest that patients use donor eggs , rather than try to do IVF with their own eggs, using alternative options such as aggressive superovulation or natural cycle IVF . While it’s true that using donor eggs does have a higher pregnancy, it’s also equally true that this option is much more profitable for the doctor. Most patients would much rather try at least once with their own eggs, rather than be pushed into using donor eggs.

It's sad that IVF clinics are not willing to put patient's interests first , and by coining all of these fancy medical terms and using all of these unproven experimental treatment, they push patients into doing treatment which may not be right for them .

The only solution to this distressing problem  is Information Therapy . Patients need to do their own research and then decide whether what the doctor is saying makes sense or not .

Not sure if your doctor’s advise is in your best interests or not ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

My IVF success story

Motherhood is is something every women aspires for.. Not all are fortunate to have babies naturally. Thanks to the advanced technology which makes the impossible "Possible".
But, it's just not that, we need skillful doctors to complete the process .

This is where Dr. Aniruddha Malpani and Dr. Anjali Malpani fit the most. They are not only good doctors but also one who can connect with the patients, educate them as well.

Before I met Dr. Aniruddha Malpani, I have had terrible experiences with a couple of hospitals in Bangalore and Mysore . Thank God that I did the right thing of not getting into the trap. Doctors were so arrogant, environment was such that ,you would feel like not having a baby at all. It took me a year to rebuild the courage and explore again.. That was when I was referred to Dr. Malpani by my friend. I got to read more about the complete IVF procedure on their website along with charges.. Everything is very much clear.

Once you enter the Malpani clinic, it's not just the ambience, but, you feel the positive energy around you which is very important . Dr. Aniruddha Malpani is very humble, well informed and full of positive vibes..and most of all very down to earth. No arrogance AT ALL.
He does make sure that he explains the entire procedure , wants his patients to be informed about the minute things .. No doctor takes that pain to educate or spends time with their patients and motivate them.. Only Dr. Aniruddha Malpani can do that. He is a blessing to the world.

They have a very good team. I would like to take this opportunity and thank the entire team..
Ms. Shonali and Ms. Rashmi at the front desk are very polite and make sure that the visitor (patient)is comfortable. Sister Lizzy , sister Neeta , Vinayak and Sister Pramodini are very good nurse practitioners who take care of the patients very well. Dr. Sai the embryologist is also excellent . And also the anesthetist . All know their job well and execute it too. Accounts department is also very transparent .. No hidden charges.. Everything is at actuals..
It's always one to one in Dr. Aniruddha Malpani's clinic. Unlike other places where nobody has any clue of what's going on.

Thanks to Dr. Anirudda Malpani and Dr. Anjali Malpani who have made my dream come true. Am 8+ weeks pregnant and in cloud 10 :).. Very excited...And hope to continue the pregnancy till the very end and become a mom :-)

In all , I should say that I have had an EXCELLENT experience at Dr. Malpani's clinic..
I would highly recommend couples exploring IVF option  to visit Dr. Malpani's. You would never go wrong with them. You could trust them with eyes shut..

By the way ,I still write to him with the reports asking for advise and he is so very humble that he does write back to me with the right and timely advise. This is a free service he is been doing.. I have never seen such a dedicated Doctor. :-)

It's indeed the Best Place to Complete the family.

Anitha

  

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