Bad Doctor or Bad Patient ?

It breaks my heart when I see patients who’ve been treated by gynaecologists who never even bothered to do a semen analysis for the husband.  These gynaecologists straight away start investigating the wife with blood tests, ultrasound scans and even a laparoscopy - and have never bothered to do a sperm test.

I always find this amazing , and when I ask my patients “ Why wasn’t the semen analysis done”, they often end up blaming the doctor -  “ But the doctor never told us to”.  Now any doctor who does tests and treatments for the wife without doing a semen analysis for the husband is a bad doctor, but I think it’s equally true that the patient is a bad patient, in that she allowed this to happen.
If a fifty years ago a patient had told me that I blindly did what my doctor told me to do, I would have forgiven them. At that time, all the knowledge was locked up in medical books and journals , and it wasn’t easy for your grandfather to find out what his treatment options were. He was forced to blindly trust his doctor , and he did so.

Today, of course, things are completely different.  You can easily do a Google search, which means you can do your homework for yourself, both before you go to the doctor so you can prepare yourself, and afterwards as well, to make sure he’s providing you the right information.  There are lots of reliable websites , and you can easily become a well informed patient , if you are willing to take the time and trouble.

There really is no excuse today for a patient not to know what their options are . Blindly trusting your doctor is not a very smart option for today's patient.  Please trust your doctor - but first verify that he deserves that trust . Trust is too precious to be given away - it needs to be earned !  Patients need to take responsibility for their decisions , and blaming the doctor for taking the wrong decision really doesn’t help the patient . It harms both the patient as well as the doctor’s reputation.

We all know that you need a man to make a baby , every infertile couple should insist that the husband’s semen analysis be tested first.  This is a simple, easy and cheap test and it’s always the simple, easy and cheap tests that should be done first, before treating the wife. A lot of people will say, “ My husband refuses to come because he thinks it’s not his problem” or the gynaecologist says “ What can I do if the husband didn’t come?”, but this is not an acceptable answer.  Infertility is always a couple’s problem and it has to be the couple which is treated together as a unit. 

Patients who do their homework, will find that not only will their doctor take much better care of them, they will be much happier with the treatment process , no matter what the outcome.

Need help with your IVF treatment ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !

Why Doctors are Reluctant to Acknowledge Their Errors

Like all humans, doctors too make mistakes sometimes; the fact that they find it difficult to acknowledge these errors is a disturbing fact. The first response always is to justify or explain it away by laying the blame one someone else like the unsuspecting assistant or nurse. We all need to live with our self-esteems intact; and doctors tend to lave larger than life egos that need protection. This is why they find it an insurmountable task to acknowledge that they are human and can err.

Doctors consider themselves to be an integral part of the helping profession and want their patients to get better. And when to their horror, they realize that they have committed a mistake that has ended up harming their patient; they find it hard to live with this bitter truth. In order to prevent cognitive dissonance, it’s perfectly natural for them to refuse to accept the truth – and even hide the fact from themselves.

The Legal Factor

One of their biggest fears is that their colleagues will think poorly of them; and that they will fall from grace in the eyes of their juniors and staff members. The other distinct worry is that in case their patients find out that an error has been committed, they might take  legal action against them in the court of law- the  consequences  of which can be dire, to say  the least.

The other fact is that doctors have been brainwashed by their professional liability insurance companies, hospital management professionals, risk management companies and lawyers to never confess to having made an error. Rather than apologize to their patients, they are told to clam up on the matter. This is because lawyers are worried that if doctors are truthful and acknowledge that they have made a mistake, it could be used against them in a court.

The Trust Factor

Doctors are also scared that if they admit to the patient that they have made a mistake, they will lose the trust of their patient and this will create a chasm in the doctor-patient relationship. And so, the knee-jerk reaction that most doctors have in such a situation is to cover up their mistakes; akin to how a child does, rather than face up to them, as a mature adult should.

It’s important that doctors learn to be honest and open; not just with patients, but with themselves too. So, even if a mistake occurs, they are able to do something constructive about it. This will go a long way in minimizing the harm caused by the error and they may also be able to take action to prevent this mistake from recurring.


Break Down the Façade

This is extremely important, not just for the patient and the healthcare system in general, but for the doctor himself. Trying to cover-up mistakes ends up in creating a major burden of guilt and shame; which can get progressively worse as time goes by! Doctors need to remember that patients can be quite forgiving, and many will accept the fact that honest errors were made. They can forgive their doctor for these – but they will never forgive a doctor for trying to mask these errors under a façade of lies.

The Unasked Questions of IVF patients

Many infertile patients have lots of questions and anxieties about their  IVF treatment.  Common queries include: Will the hormones cause me to become fat ? will they cause me to run out of eggs ? will they cause ovarian cancer?  Many of these anxieties are much worse when you are using a third party - for example, when doing donor egg IVF. What does the egg donor look like ? what will my child look like ? will people suspect ? will my baby be normal ? And when it involves surrogacy , the anxieties are multiplied a hundred fold. Will the surrogate be responsible ? will she take good care of herself during her pregnancy ? will she hand over the baby to me after birth ? will I be able to manage all the legal processes ?

IVF treatment is complicated because there are so many moving parts , all of which need to be synchronised in order to make sure that it goes off flawlessly.  It's a daunting exercise, and it's perfectly normal to have all these anxieties.

Sadly, some patients suppress these anxieties . All these questions prey on their mind, but they are scared to ask them.  This is why they never get any answers , and when these anxieties are repressed and these questions remain unanswered, the risk for problems actually increases.  Thus, when patients don’t hear back from the doctor , they automatically assume the worst, or they think the doctor doesn’t care. think it’s important that patients air their worries and share their concerns with the doctor.  After all, the doctor can’t read your mind and it’s very unlikely that you’re going to have a question which he hasn’t encountered before . It's far better for both of you that you be open and let him know what’s on your mind , so that he can put you at ease.  And even if he can’t do so, at least you will have peace of mind that you did ask for your doubts to be clarified. If you don’t, it's quite likely to cause you sleepless nights and unnecessary anxiety - and you will kick yourself when you find out later that it was a very basic question , and he could have reassured you with just a simple email.

This is why it’s important for patients to make sure that all their doubts are clarified before proceeding with elective treatment such as IVF, especially when there are so many emotional issues involved in the process.

Have questions about IVF treatment ?  Ask me and I'll be happy to reply. My email is [email protected]

How follicular studies ( ultrasound scanning) reduce your fertility

When couples get concerned about not getting pregnant , their first visit is usually to their gynaecologist. The first step the gynecologist advises is usually follicular monitoring . This means they refer the patient to a sonographer, who does serial ultrasound scans to track the growth of the follicle . The rationale is that this allows the doctor to track ovulation, so that she can advice the couple as to when to have baby making sex , and maximise the chances of their getting pregnant .

This is actually the worst of both possible worlds , because it converts a pleasurable bedroom activity into a clinical activity . It is no fun having to go to the doctor to get prodded with an ultrasound probe. The position itself is highly undignified , and having to strip for scans can be quite embarrassing.

Even worse, this scanning creates a lot of tension between the husband and wife . The husband is upset that the spontaneity of pleasurable sex is removed . Often the wife insists that they have sex only at the time which is prescribed by the doctor , which means the husband feels deprived. Scanning wastes a lot of time and energy , because the wife needs to commute to the scan center; wait for her turn; and then take the report to her gynecologist, who tells her what to do .

To add insult to injury, because the scanning is done by a sonographer and not by the gynaecologist , the advice patients get is of poor quality. Thus, most doctors will tell patients not to have sex until after the follicle ruptures –after ovulation. As a result of this monitoring, husbands are then forced to “store up their sperm” and then deposit them all at one shot after his wife ovulates. This is the only purpose which scanning achieves. This is actually bad advice, because after ovulation, the cervical mucus dries up, and the woman actually becomes infertile , because the sperm can now no longer swim up the egg. This means that follicular monitoring actually ends up causing infertility , rather than treating it.  This is one of the reasons so many women get pregnant when they stop doing these pointless scans !

The scanning also increases the wife’s anxiety . She has very unrealistic expectations every time she has well timed intercourse after the scans , because she feels that if the follicle has burst in the last 24 hours and the egg is in the tube and she then has sex at the right time , she is bound to get pregnant . When she doesn’t get pregnant, her mind starts playing all sorts of games with her, and she starts wondering if her tubes are blocked or if her eggs are bad. Doctors also contribute to this kind of unrealistic hope on the part of the patient by providing what they feel is reassurance by saying the cycle is perfect, and that she will definitely get pregnant this month. However, when she fails to conceive cycle after cycle, she starts losing confidence in her doctor. She gets fed up and frustrated, and once she has stopped trusting one doctor , she is no longer willing to trust any other doctor .

The husband often bears the brunt of the monitoring. He gets squashed , because he is forced to perform when his wife tells him to, whether or not he is “up” to it !  This wreaks havoc with his schedule, and this is  specially true for businessmen who need to travel a lot. When the wife calls up and says you need to fly down right now to have sex with me because the doctor told me I have ovulated and I need you stat, he has to change all his plans. This can be very hard, if he has lined up business meetings and is in another city ! He finds it very hard to be able to comply with her demands , and starts resenting being treated like a performing stud, whose only job is to act as a sperm donor.

The wife also feels upset , because she feels that her husband is being rigid and is refusing to cooperate. He wants to put business ahead of his family, and doesn’t understand how important  it is for her to get pregnant asap. Even worse, if he cannot fly down, she feels her entire cycle got wasted because of his lack of cooperation, and she will now have to start all over again from next month . This creates a lot of tension between husband and wife .

What’s worse is that often doctors are completely clueless about the harm which they cause to their patients by advising follicle monitoring . They think of it as being a simple , inexpensive, easy and non-invasive procedure , and cannot understand why the couple is making such a big deal out of it.  They  forget about the amount of anxiety which this causes – and the amount of time which the poor patient has to wait – travelling to the clinic and waiting for the scans .

Follicle monitoring actually serves no useful purpose at all in my opinion. If women do want to track their ovulation , they can do it much more easily by using online free fertility monitors; tracking their cervical mucus ; and by using LH ovulation test kits . These are more convenient and more reliable, since they let the wife know in advance that ovulation is going to occur, so she can time baby making sex much more  effectively - before she ovulates.

Even if the doctor does want to do follicle monitoring ( for example, to check the endometrial thickness), then one cycle is more than enough to educate the patient , because she can correlate the scan findings with her cervical mucus and LH test kit results. If your doctor asks you to go for follicular tracking month after month, you should look for another doctor !

Need more information ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !

IVF Patients who should not come to us for their IVF Treatment

We take pride in the fact that we’re a boutique IVF clinic which provides high quality services . One of our specialties is taking care of patients who have failed IVF cycles before. These are challenging patients , and because we can focus our energies and extensive experience and expertise on them, it's fun to succeed when another IVF clinic has failed.

However, just like there are some patients who we think we are the best clinic for, there are also some patients that should not be coming to us for their IVF treatment.

The first group is patients who have unrealistic expectations from their IVF treatment.  I understand that everyone wants to get pregnant in their first IVF cycle, but this is a holy grail we have still not been able to achieve. Patients who have unrealistic expectations are very hard to manage because not only are they miserable and unhappy if their cycle fails, they also end up getting upset and angry with their IVF doctor for no fault of his. Unhappy patients make for unhappy doctors - and this can be a toxic combination.

The second group is patients who want a sweet talking doctor - someone who will provide false hope. While I am very optimistic, I am also the kind of doctor who calls a spade a spade and while the truth can be cruel, I think false hope can be crueller. We prefer treating patients who have the maturity to accept the truth , and to be able to deal with it.  We want patients who do their homework, who are well informed and who are willing to participate in the decision making process - not those who want the doctor to make all the choice for them because they want to be spoonfed .  IVF is an elective treatment , and patients’ preferences are extremely important in deciding the course of action, so we want patients who are willing to speak up and who have the confidence to make their own decisions for themselves, in partnership with us.  We don’t want patients who want to leave everything up to the doctor , and who refuse to think for themselves.

We work hard at making sure our patients get the best medical care, and we enjoy treating patients who respect the effort we put in - those who understand that you can judge the quality of IVF care by assessing the process the clinic follows , rather than just the outcome, which is not something which is in our hands.

I believe that doctors get the patients that they deserve and patients get their doctors they deserve. If patients are not a good fit for us , then I think it’s better that they don’t come to us for their IVF treatment . After all, it's not possible for a doctor to keep all his patients happy all the time, if they are not in sync with each other. When both the doctor and patient are on the same page, both are going to much happier !

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

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The problem with IVF clinics and surrogacy in India - Hindutan Times article

In the booming business of gestational surrogacy in India, where IVF clinics promise "five-star medical facilities", "high success rates" and "extensive choice" for infertile couples, stories of DNA mismatches and abandoned babies, and several unscrupulous practices being followed by IVF clinics only seem to suggest that commercial surrogacy in the country is almost in a state of lawlessness.
http://www.hindustantimes.com/india-news/outsourcing-motherhood-india-s-reproductive-dystopia/article1-1373360.aspx

This is a very honest and truthful article which describes what's wrong with the IVF and surrogacy in India. It's criticism which doctors should take to heart. The moral is simple - the patient  needs to beware when selecting an IVF clinic, so that they don't get taken for a ride !

IVF Clinic fees - why is there so much variation ?

IVF can be an extremely expensive treatment , and this is something most infertile patients are acutely aware of . To make matters worse, there can be a lot of variation between the fees which IVF clinics charge.  A lot of patients aren’t sure about why there is so much variability , and some of the naive ones will just select a clinic based on the fact that it offers the cheapest rate, but this is often not the smartest way of making such an important decision.  While they may end up saving a certain amount of money up front, they may actually end up causing themselves harm because they then go to a clinic which cuts corners , or has low success rates. Of course, this doesn’t mean that a clinic which charges the most is the best either ! This is why patients need to do their due diligence , and analyse exactly why and for what procedures the clinic is charging its fees for.

Sometimes it’s hard to compare fees - it's often like comparing apples and oranges ! This is why patients need to read the fine print , and figure out what’s included in the IVF treatment charges and what’s not.

Some clinics will provide an itemised list , and for every additional procedure which they perform, whether it’s a blood test or an ultrasound scan, they will charge more.  Other clinics will offer a package rate which includes everything , so that patients don’t need to worry that they will be charged extra for each additional procedure.  Again, there are pros and cons for both these options, and it’s important that patients understand exactly what is excluded.

Unfortunately patients aren’t sophisticated enough to ask important questions.  Thus, one of the questions you need to ask is - What happens if the cycle gets cancelled ? Do I lose all my money ? Do you refund part of it ? or most of it ? Once you start a cycle and then it gets cancelled, not only do you have a zero chance of getting pregnant, you’ve also invested a lot of money which, in one sense has now gone down the drain.

It’s equally important to find out whether the clinic charges extra for additional procedures such as ICSI ; laser assisted hatching ; or a blastocyst transfer . We provide all these as part of our standard IVF package, to maximise our patient's chances of success.

You also need to find out whether the clinic charges the same amount if you need to do a second cycle.  Some clinics will charge exactly the same, whether it’s a second or the third cycle , while others will offer a loyalty discount , and reduce the fees for the second and third cycles.

If you ask all these questions up front, you will have the answers you need, so that there are no unpleasant surprises afterwards.  You will also find that certain clinics offer additional options such as money back packages or refund programs , which help to minimise some of your financial risks.  You should explore these as well !

What we have learnt over time is that most patients are not looking for the cheapest IVF clinic, or the one which offers the lowest fees, because they do understand that treatment is expensive.

What they are really looking for is value for money and the only way for patients to get this is to do their due diligence.  Compare IVF clinics ! Find out exactly what’s included , and what’s not , and then make a decision as to what is best for you  .

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

Are you unhappy with your IVF doctor ?

Most IVF patients don’t know what to expect when they start their first IVF cycle . They are quite naïve and don’t know the difference between a good clinic and a bad one. They believe that all clinics are the same, and go to the one which is the nearest; or the one which is least expensive; or the one their doctor refers them to. They know that IVF can be complex and expensive, but are willing to go through all that pain because they are so keen on having a baby.

However , many find that the quality of care which they receive leaves a lot to be desired, even though they are spending so much money. They often don’t get the meet the senior doctor; or they have to wait for hours in order to do so .  They usually have to talk to an assistant or a nurse, most of whom are quite clueless about what is happening.  There is often a new doctor on duty every time they go to the clinic, which means they have to repeat their history each time.

Many clinics will batch their patients together ( because they have to depend upon an IVF specialist or embryologist who comes out of town), which means that often groups of 20 or 30 patients are being treated at the same time . This becomes an assembly line practice , rather than their getting individualised treatment. All the staff seems to be in a rush , because there are so many pickups and transfers being done in a day . The doctor has only about 10-15 minutes to complete a procedure, so he never has any time to sit down and talk to the patient. Lots of money is taken under the table, for “extra” procedures which the doctor suggests at the last minute, claiming that they will improve success rates. They often have to shuttle from a particular lab to a particular chemist  in order to do blood tests and to buy medicines; and then have to wait until they get the results and find out what they are supposed to do tomorrow. There is no clarity and no treatment plan, and everything seems to be done on an ad-hoc basis.

There is very little documentation , and no transparency as to what's going on – for example, how mahy follicles are growing on the scans; how many eggs were collected ; how many embryos are being transferred ; or what their quality is. They don’t get a treatment summary or photographs of their embryos. which often means that the entire patient experience is very frustrating .

While patients can accept the fact that IVF cycles fail because the outcome of a biological process is not in any doctor’s hands , they're often very disappointed with the poor quality of personal attention and care which they have been given.

Does this sound familiar ? If you are unhappy with the quality of care you received at your IVF clinic, we are happy to offer you a far better solution at Malpani Infertility Clinic . We are boutique full-service IVF clinic which offers all services under one roof,  which means you never need to go anywhere else . We have only two doctors – Dr Anjali and me, and we take care of all our patients ourselves. We have a full-time experienced embryologist, Dr Sai, who works full-time in our IVF lab . We treat patients throughout the year , so we offer you an individualized treatment protocol, tailored to your cycle. Care is personalised and one-on-one . We are happy to answer all your questions , and we take the time needed to explain to you exactly what’s happening during your cycle. I am just an email away, and answer all my emails myself within 24 hours.

Don't believe me ? Please visit www.drmalpani.com and email me to see how quickly I reply !

Our documentation is excellent , and we routinely provide photos of your embryos so you have peace of mind that you have received high quality care . If you are frustrated about the care you're getting at your IVF clinic, you might want to consider coming to us . It’s true that we are more expensive , but given the high quality of care which we provide , and our high pregnancy rates , it is actually extremely cost-effective to come to us for your IVF treatment !

Want me to send you a customised IVF treatment plan ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !

Using the internet for patient education

I am an evangelist for patient education and I think the internet is a great resource for patients, because it allows them to learn more about their problem and their treatment options . I encourage patients to make the most of the fact that there is a wealth of information available online.

While a lot of patients are quite gung ho about using the internet , and are proud and pleased with their ability to be able to extract the information which they want, there are also some who’ve had their fingers burnt.  They say we get confused on the net and we don’t know what to trust . There's a lot of contradictory information out there, as a result of which we are always second guessing ourselves and our doctors . In fact, lots of doctors warn patients to stay away from the internet, as a result of which the internet has a pretty mixed reputation as far as patients go.

Patients who use the internet fall into two groups which explains why they have such varying experiences. Some are sophisticated.  They’ve done their background reading, and because they’ve done their homework from reliable sites,  they have a basic foundation and understand the terminology and medical jargon.  They have a big picture , and they can build on this by visiting bulletin boards, forums or other sites, so that, even if these are poor quality sites, or contain conflicting information, they’re able to make sense of it . They have learned to extract the good and ignore the bad.

Many patients, on the other hand, are not sophisticated enough to understand that not all sites are created the same.  They pretty much take every site at its face value, which is why they get so easily swayed, depending on which particular site they visited that particular day.  This is why it is so important that when patients use the internet to find information, they need to have a structured approach.

Smart doctors will help patients to make sense of what they unearth, and will guide their patients to reliable and trustworthy sites. The best doctors will accept that educating patients is their responsibility , and will take the time and trouble to create patient educational materials in local languages.

Your IVF Medical Records are worth their weight in gold

When patients ask me for a second opinion after they have failed an IVF cycle in another clinic, I ask them for a copy of their medical records.  Sometimes they say “ We don’t have a copy,” so my answer is, “ Fine, then ask the clinic for a copy of your treatment summary”.  Then the answer is “But the clinic is refusing to give it. They say -  it’s not our policy to provide these records, and we don’t do this”. 

I find this frustrating, and I suggest, “ Write them a letter . Perhaps they’re ignoring your verbal requests, but will reply to a written request" . Then the response is  -  “We haven't get any reply”.  Then I tell them, " You need to escalate. Mark a copy to the head of the clinic , and the CEO of the hospital.  If you still don’t get a reply, then get a lawyer to write the letter on your behalf - I am sure a letter from a lawyer will not be ignored”.

I agree this is frustrating for patients . I cannot understand why a clinic will refuse to share medical records with the patient.  This is part of a doctor’s job and the doctor’s not doing a favour to the patient by giving them their records.  This is a legal duty which the doctor owes to the patient , and it’s the patient's legal right to get their records.

Doctors don’t understand the harm they do by refusing to be transparent and open by sharing records.  This creates unnecessary suspicion in the patient’s mind , and a lot of grief as well.  The patient will start doubting your integrity and your intentions. "  What do you have to hide that you’re not willing to give me my records?”

Part of the problem  is that doctors continue getting away with this behaviour, as a result of which this seems to have become the norm for many IVF clinics, but this is not acceptable or tolerable.  And I think doctors need to start putting pressure on themselves and on their peers to make sure that records are provided routinely and proactively to all patients.  This helps to increase trust and confidence.

What can the patient do ? Patients need to prevent these problems from occurring, so they need to ask a simple question before they sign up for IVF in the clinic.  " Will you provide photos of my embryos ?" The standard answer from any good clinic is, “ Yes , we do this routinely". However, if they don’t , then this should be a red flag.   Every medical record contains vital information and even if the cycle fails, this information can help the doctor to craft a better treatment plan for your next cycle . This is true, whether you go to the same clinic , or whether you go to another one.

Some doctors refuse to share medical records is because they want to keep their patients captive. They hope that by not releasing the record, the patient will not go to another clinic.  This is extremely short sighted and while it may work in the short term , it causes long term damage, not only to that individual doctor, but to the reputation of the entire IVF fraternity . This is something which is going to cause all of us a lot of harm, if we allow some doctors to get away with this kind of behaviour.
I was very hopeful that once the ART Bill would get passed by the Parliament , a lot of this would get regulated and straightened out, but that doesn’t seem to be happening, unfortunately, because this poor Bill has been stuck in the Parliament now for the last seven years. In any case, as responsible doctors, we need to take action proactively, rather than wait for the government to regulate us.


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

Our IVF Success Rate is 80%

I was speaking yesterday to a VC ( venture capitalist) who was looking at investing in a chain of IVF clinics in India , and he asked me, " What’s your success rate?"  I explained that the average is about 46%, but this is a complicated question, and the answer depends on multiple variables, such as the age of the woman; how many eggs she grows;, and what the quality of the embryos is . He cut me off and said, “Oh, I spoke to an IVF doctor who says his success rate is 80% and you say that yours is only 46%, which means you can’t be a very good IVF clinic?  " And he then added “I understand that realistically success rates in IVF cycles are in the range of 40% to 50% and that any doctor who claims to have a 80% pregnancy rate for all patients is obviously trying to take me for a ride - and I’m not an idiot !"

There’s a lot of medical inflation these days - and it’s not just the prices of medical treatment that are going up - it’s the tall claims which IVF doctors are making about their success rates ! They bandy figures , and there is no check or control.  They can pretty much say what they like , and they don’t have to prove it one way or the other, which means patients are supposed to take their word for it.
These kinds of claims cause a negative vicious cycle,  because patients then start getting unrealistic expectations . It then becomes a game of one-upmanship amongst IVF clinics, who then start trying to compete with each other as to who can make the tallest claims ! They inflate their figures and manipulate their success rates.

The trouble is that when they make outlandish claims, they start becoming the object of ridicule amongst educated patients - after all, patients aren’t fools. Of course not all patients are smart enough to be able to differentiate between a doctor who is stretching the truth and, unfortunately, these are the ones who get taken for a ride.

Effectively this kind of manipulation boils down to telling the patient lies.  While it’s possible to fool some of the patients some of the time, it’s not possible to fool all the patients all the time - and this kind of falsehood will come back to haunt the doctor.

It’s easy to make these tall claims because IVF clinics are selling hope.  But you can’t continue living on false claims on an ongoing basis. After all , patients talk to each other, they do their homework, and they countercheck what’s happening on the net . As it is, they don’t trust doctors anymore, because we have betrayed their trust, so they take everything any doctor says with a large pinch of salt.  IVF doctors should understand that their actions have consequences , and making these kind of inflated claims harms all IVF clinics - even the good ones, because patients start treating all IVF doctors as cheats and crooks.

Talk is cheap, and while it’s easy to make claims, at some point you need to deliver results. When you fail to do this, it’s going to create a lot of unhappiness and angst, which is then going to cause a backlash, which ends up hurting not just that IVF clinic who’s making those tall claims, but all IVF clinics as well.

The reason doctors continue to get away with this is because there is very poor documentation , and most patients aren’t still sophisticated enough to ask probing questions. However , doctors who make these kind of tall claims actually end up becoming a laughing stock,  because their colleagues and peers have a very low opinion of them . And the market itself is quite sophisticated and knows the reality, which means IVF drug distributors, pharma companies, laboratory equipment manufacturers and even their own staff know what the truth is . At some point, Satyameva Jayate - the truth will prevail.

Need help in making sense of IVF success rates ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !

Why are some IVF doctors so careless ?

New IVF clinics are springing up left, right and centre all over the country.  Gynaecologists feel that IVF is a very lucrative specialty and they all want to start their own IVF clinic, rather than refer their patient to an IVF specialist.  After all, why lose that income?  And it seems to be such an easy thing to do ! All you need to do is buy the equipment , and then you are ready to start ! Most of these are senior gynaecologists, and after years of practice, they are quite rich . They are quite happy to attend a one week workshop, which makes them IVF specialists , and then find some freelancer who will travel to their clinic and provide them with the IVF services which they require.

Sadly, they grossly underestimate the amount of time and energy it takes to run an IVF clinic , and they often end up with very poor success rates.  However, most of them are not even willing to acknowledge the reality that they are doing their patients a major disservice.  Not only do they end up fooling their patients, they end up fooling themselves ! They justify their dismal pregnancy rates by saying their patients are very difficult ; or that the batch of injections used for superovulation was bad; or that the culture medium was poor quality; or that the incubator did not work well - anything or anyone , other than themselves. 

They refuse to take responsibility for what’s happening , and I think this is partly because they have a guilty conscience . They know that they are doing a bad job, and they start covering up the truth.  Not only do they not share any information with their patients, they actually lie to them ! They don’t tell patients how many follicles are growing on the scan, or how many eggs they’ve retrieved , or how many embryos they transferred. Some even go to the extent of manipulating the number, so they can "donate" extra eggs and embryos to other patients.

 They don’t bother to give patients IVF treatment summaries ; or discharge records ; or photos of the embryos - and this is the same gynaecologist who always provides the patient with a DVD of the laparoscopy;  or with a written summary when he does any other medical procedures, such as a D&C or a Caesarean Section ! Even if he does provide a summary of the IVF treatment, it’s done so poorly that the documentation is not even worth the paper which it is written on. Complaining afterwards does not help, since the damage is already done.

There is a lot of fudging during the IVF treatment, and gynaecologists get away with this sloppiness for two reasons.  One is that their patients aren’t smart enough to demand better.  Sadly, IVF patients don’t know what they should expect, and when they end up blindly trusting their doctor, many get taken for a ride.

Even worse, sometimes these doctors don’t understand the damage they do.  They feel - So what if the embryo died ? So what if the patient didn’t get pregnant - it’s not the end of the world.  These same doctors would never have the guts to set themselves up as gynaecological oncologists or start treating patients with cancer of the cervix after attending a one week course, because they understand that oncological surgery requires special technical skills which they don’t have . Cancers can be life threatening , and this is why they stay away from that field . However, they take a much more casual approach towards acquiring IVF  skills, because they feel that there is much less at stake. IVF is deceptively easy to do , but they don't realise that doing it well requires experience, expertise and full-time dedication.

Sadly. a lot of IVF patients end up paying the price for this attitude. It's true that when an IVF cycle fails, the patient doesn’t die (unlike a badly performed Wertheim's  hysterectomy for cancer cervix, where the surgeon reduces the patient's life expectancy significantly) . However, a failed IVF cycle does cause the death of the patient’s hopes and dreams . The biggest tragedy is that if the patient had gone to a good IVF clinic, she would have got pregnant, but a bad IVF clinic killed her chances.

One solution is introducing some sort of regulation to ensure quality control, but given the way the Indian system works, it’s unlikely that’s going to happen.  This is why educating patients who know what questions to ask is the more effective way for now of making sure that IVF doctors can no longer get away with their careless habits.


Not sure if your IVF doctor is doing a good job ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !

Why is it so Hard to Change IVF Doctors ?

Patients find it surprisingly hard to change their IVF doctor , even when they are not happy with him.
When patients  are choosing an IVF  clinic for the first time, they’re pretty clueless and naive , and are not sure how to differentiate a good clinic from a bad one. This is why they sign up, often with the one who’s closest to them; or the one who’s the cheapest ; or the one who has the biggest ads.
However, after going through an IVF cycle, lots of patients are extremely unhappy with the way they’ve been treated.  They find the doctor’s usually not available; they are made to wait for hours on end; they are treated with disrespect; there is no standard treatment protocol and everything seems to be done on an adhoc basis; there is no transparency or openness ; and they keep on being asked to pay extra for additional services, often in cash, as a result of which the total bill comes up to much more than what they’d originally budgeted for.  So when the first cycle fails, you’d logically expect them to search for a better IVF clinic, where they'll hopefully have a better experience . However, a lot of patients, even though they are extremely unhappy with their present IVF doctor, continue staying with him and do a second cycle in the same clinic.

I find this extremely hard to understand.  I can forgive making a mistake once, but why would you compound the mistake by repeating it again ?  I think, there are many reasons for this.

The first is one of denial.  No one wants to accept the fact that they’ve made a mistake so they'd rather stick with the known devil, than hunt for someone else. After all, what's the certainty that the next IVF doctor will be any better ? Also, they’re hopeful that the doctor will improve or will do a better job now that it’s their second cycle . Their naive hope is that he will have a soft corner for them, or will try harder, since it’s their second cycle,  and they have a relationship with him.

A second problem is one of attitude.  Lots of patients would rather behave as passive victims and blame the doctor and still continue with him, rather than take the effort and the energy involved in finding a new doctor. This can be hard work , and they don't want to do that.  And a lot of them justify this be saying that they are worried that they could end up going from the frying pan to the fire. It's much easier to stay, so this becomes their default option.

Thirdly, a lot of them aren’t confident enough that they’re going to be able to make the switch . When they try to do so, the existing clinic creates a lot of hurdles in their way ! They provide both a carrot as well as a stick. The barrier is - “Sorry , we will not give you your records, because this is our clinic policy that the records are our property” ; and the carrot is, “Fine, we give you a 20% discount if you stick with us and don’t go anywhere else”.

Part of the reason for this reluctance to switch comes from what psychologists call cognitive dissonance.  Patients think of themselves as being smart , and when they are then confronted with the reality that they weren’t smart enough to choose a good IVF doctor , rather than accept the fact that they made a mistake, it’s much easier to rationalise their choice by saying, “ Well maybe the doctor is good and it's my fault that I can’t see his finer points and that’s why I’m better off sticking with him."
 The other problem is what is called loss chasing behaviour, which often means that when we make a mistake , we have a natural human tendency to compound the mistake even further by trying to reduce its impact.  Ironically, this has exactly the opposite effect and we dig a deeper grave for ourselves by throwing even more good money after bad.

Patients need to be aware of these psychological traps which affect our ability to learn from our mistakes . In order to improve , they need to step outside themselves , and understand that the first cycle cost is a sunk cost.  There’s nothing they can do to recover this. Rather than make a bad situation worse, they need to learn from the mistakes which they made in the first cycle , and do a better job in their second cycle . One of the most effective ways of doing this, is to analyse your learning and then convert this into action by finding a better IVF clinic, who can do a better job.
It’s much more likely that your second clinic will be better than your first ! This is because you are now a smarter and better patient , and because you know exactly what problems you had with your first clinic , you can ask far more intelligent questions in order to make sure that you will not encounter the same problems.

I agree, this is a hard earned lesson, but it should be put to good use because this is the only way you will be able to maximise your chances of having a baby !


Need help in finding a better IVF clinic ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !

Is IVF useful for women who have repeated miscarriages ?

Women who have had repeated miscarriages are often very frustrated . Not only are they extremely upset and unhappy with themselves , because their body doesn't work properly , but they find it very hard to get reliable medical advice . Each doctors gives them a different opinion; and websites will often provide diametrically opposite and contradictory information . Patients are completely confused and lost , and don't know whom to believe , and what to do next . A lot of them get paralysed , and many just give up.

Recurrent pregnancy loss is a very confusing problem , and we do not have the tools and technology to be able to pinpoint what the problem is for the individual patient . While we do know in general that the commonest cause is a genetic problem in the embryo , this is often very difficult to prove or to establish for an individual patient. This is why we often resort to empirical therapy - treatment based on experience with other patients , rather than on running tests for that specific patient , in order to try to find a specific diagnosis, because this is often an expensive wild goose chase, which provides no useful information.

Patients are extremely unhappy when we cannot provide them with a specific diagnosis . They feel that if we can't find the problem , we will not be able to find a solution . Fortunately , this is not true . While we are very good at being able to pinpoint problems , assisted reproductive technology today is very good at bypassing these .

We are not able to make a diagnosis for most patients who have had recurrent miscarriages . Their reproductive system is anatomically normal, as are their chromosome tests . We are completely in the dark as to why she is miscarrying , because our tests are fairly crude, and not precise enough.

Imagine the amount of stress the poor patient goes through ! She doesn't know whether she should try getting pregnant again , and is very scared even when she does get pregnant , because she is petrified that she will miscarry again. She not sure whether she needs treatment , and if so , what treatment she should take .

Different doctors advice different treatment options . Some talk about immune therapy , others offer surrogacy , while some state that using donor eggs is their best option.

Interestingly , for some of these patients, IVF with their own eggs can be a useful treatment option . This may sound counter-intuitive. After all, they are getting pregnant on their own, and do not have a fertility issue, so why should they spend money on doing IVF ? Isn’t IVF a treatment for infertile patients ?

Interestingly, IVF improves reproductive efficiency by telescoping time . In the natural course of events, she would produce only embryo every month , and some of these would be genetically abnormal. It would take her a long time to produce a genetically normal embryo , which would give her a healthy baby , because this is such a random affair. The beauty about IVF is that it allows us to create multiple embryos in one cycle .  We can help her to make 10 embryos in one cycle, and then allow them to compete amongst themselves , so that we can pick the best blastocyst, and then selectively transfer this in her uterus. Rather than adopt a hit and miss approach , which could consume a lot of time , we are helping her to maximize her chances of hitting the jackpot quickly , by resorting to IVF . Think of someone who's buying a lottery ticket . Rather than buy just one lottery ticket every month , over a period of a year , she could buy 12 lottery tickets in one month , and hope that one of the tickets she bought could be a winning one . Yes, it's true that this is a gamble . Whether she buys a ticket one at a time, or all at once , this will not affect the chances of selecting a winning ticket.  However, she can trade money for time, and save herself valuable time by having many embryos to select from on one cycle.

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

Dr Malpani's interview on practise management at DocPlexus

Doctors need to help each other so we can practise more efficiently and effectively. The problem is that we tend to compete with each other and "hide" all our secrets, rather than sharing them so that we can all become more successful. We need to grow the pie rather than squabble over the size of our slice by trying to "defeat" other doctors.

Today in the series of DocPlexus KOL Interviews, we have Dr. Aniruddha Malpani, he talks about effective practice management for Physicians, and also provides answers to exclusive queries asked by doctors on DocPlexus.in

http://www.docplexus.in/news/310ed51c-bb08-4169-ba66-cb476f9e5f0c/exclusive-interview-with-dr-aniruddha-malpani

Is it Really Unexplained Infertility?

Infertility is the inability to conceive, and in some couples, the exact cause is undetectable. Doctors label this condition as “ unexplained infertility” . In these couples all the investigation reports come back as normal. However, only 10% of infertile couples can be labeled as having unexplained infertility. It is also one of the most misused diagnoses by doctors and IVF specialists.

Most IVF clinics operate on an assembly line model and many doctors don’t have the time to pay individual attention to their patients. The patient will be prescribed a standard battery of tests; once these tests come back as normal; the doctor loses no time in labeling the patient with the “unexplained infertility” tag.

Incorrect Evaluation

The unfortunate part is that not all of these patients have been correctly evaluated. The diagnosis of unexplained infertility simply means that even with the current day medical technology at our disposal, we are not always able to pinpoint the reason behind the inability to conceive. Our tests and investigations aren’t accurate enough to be able to identify all the causes. However, this should be a diagnosis of exclusion.

Some Facts

• There are times, when a doctor may not bother to do the exact tests that can help reach the correct diagnosis. This could be because he may not be well-informed or up-to-date with his information
• At times, the town his clinic is in may not have the latest, sophisticated testing facilities. For example the blood test for AMH levels gives an indication of the ovarian reserve of the patient. Patients with low ovarian reserve have difficulty conceiving naturally and are best managed by IVF. This particular diagnosis is very commonly missed by gynecologists, and patients end up wasting a lot of time trying to have a baby in their bedroom, because the doctor has mis-labeled them as having unexplained infertility
• The other aspect of this problem is that not all the causes will have symptoms or signs;  and a doctor will have to literally hunt for the right diagnosis by ordering the right tests
• Similarly, the diagnosis of male infertility tends to get overlooked, because the semen analysis has not been done properly

Too much testing

• On the opposite side of the spectrum are IVF specialists who will over-order tests (PCR testing for TB or tests for NK cells) in order to reach a diagnosis. Not only are many of these tests unnecessary, but they also create a considerable amount of harm as incidental findings surface in the test results. Typically, these have no  impact on the patient’s fertility; however, the doctor will then proclaim that they are actually  the cause for the  infertility
• In reality, a number of these abnormal test results have no clinical significance at all, and many will be found in fertile couples too.  In one sense, her infertility is still "unexplained", but  when the patient is told that the abnormal test result  is the cause for her infertility, she is willing to accept this "diagnosis".  Her perception is that since the right diagnosis has now been made, the correct treatment can be started which will help her get pregnant.

A Different Philosophy

Our philosophy is completely different. We believe that the question should NOT be “Why is the patient not getting pregnant?” Rather, it should be “What can we do to help the patient get pregnant?” After all, no one cares about problems – we only care about results – about helping people have the babies they want! This is why we use a success-oriented approach that bypasses problems!

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

Low molecular weight heparin does not help women with recurrent miscariages

Patients with recurrent miscarriages ( recurrent abortions, RPL or recurrent pregnancy losses, or habitual abortion) are very frustrating to treat, because nothing seems to work consistently.

It's become very popular for gynecologists to prescribe heparin injections for these women. These  are expensive and painful, but are being marketed very aggressively by pharma companies. Doctors are happy to prescribe these, in the misguided belief that "something is better than nothing" !

However, a study published by Ekkehard Schleussner, MD, PhD, from Friedrich Schiller University Hospital, Jena, Germany in the May 5 2015 issue of the Annals of Internal Medicine showed that Low-molecular-weight heparin (LMWH) does not increase ongoing pregnancy or live-birth rates in women with a viable pregnancy and unexplained recurrent pregnancy loss (RPL).

Sadly, most doctors will never read the study -  and no pharma company is going to share it with doctors either ! Patients with RPL will continue to be over-treated.

Why Some Patients Quit When an IVF Cycle Fails

IVF is one of the most complicated treatment options for infertile couples. Those who opt for it know that it is their last chance at having their own baby. Their desires, hopes and emotions are all very tightly woven into the outcome of this procedure. Unfortunately, many patients who undergo IVF treatment have very unrealistic expectations about the results.

It’s not uncommon that many women stop further treatment if their first IVF cycle fails; this despite the fact that they know they are essentially denying themselves the possibility of success by doing so.

What Actually Occurs

The number of dropouts after the first IVF cycle fails is very high. These women stop any further treatment and give up on their quest for a baby. From a practical viewpoint, when a couple decides to undergo any specific treatment, they would normally be expected to continue it until the desired results are achieved. However, instead of persisting and opting for more cycles, many couples back-off if their first cycle fails. Many of these couples will banish the thought of IVF from their minds , and some will also start thinking of alternative options such as surrogacy.

Impacting Factors

A range of factors play a role in this decision to discontinue with IVF treatment:

• It is a fact that IVF is expensive and the failure of a cycle also becomes a major financial setback. Not only are the different procedures involved in it expensive, but the medications and tests required can burn a sizeable hole in your pocket too.  In such instances, couples have no option but to abandon their attempts at IVF and try to look for cheaper alternatives (which just may not be effective at all)

• At times, the stress factor has a role to play in this decision and couples are unable to handle the mental stress that is part and parcel of IVF. They get emotionally exhausted with dealing with all the uncertainties, during as well as after the IVF cycle. They feel they just don’t want to deal with the same rollercoaster ride again. A patient who is unprepared or one who has not been counseled properly at the outset, is unable  to cope with the stress  of failure and chooses  to back-out

• In some instances, it’s the doctor who is responsible for misleading the patient. At the time of the first consultation, when doctors want to sign up a new patient for IVF treatment, they are usually very optimistic, and they make many false promises. They quote exaggerated success rates, and try to do their best to induce the patient to start the treatment with them . When the IVF cycle fails, they then abandon the patient, who feels cheated and misled. Thus, the same doctor who told her that the quality of the embryos is Grade A at the time of transfer then turns around and blames poor quality embryos for the failed implantation when the cycle fails.  After this kind of bitter experience, it's quite understandable why many patients are no longer willing to trust IVF doctors.

The media is also responsible for demoralizing the patient.  The media being what it is, it tends to highlight only the positive aspects of IVF. The entire procedure and the success rates are glamorized and overrated. They don’t talk much about the failure rates and the picture they paint is very pretty to say the least. This leaves patients unprepared  for failure and when their IVF cycle fails, they are unable to  cope with the  fact, and opt out of the treatment

These problems can be overcome by empowering the patient with the correct knowledge of IVF, and good counseling can make a world of a difference! IVF failure doesn't mean the end of the world. A careful analysis can find the causes and areas of improvement to make your next IVF cycle more successful. IVF is not a one-time hit or miss treatment and patients need to be prepared for the fact that they may have to undergo more than one cycle to achieve a pregnancy.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

Can DNA testing help you to lose weight ?

VLCC is one of India's largest beauty, weight loss and fitness chains . They have launched a new product called VLCC DNA Slim and they took out a full page ad in the Times of India today to promote this.  I was intrigued about how DNA testing could be used to lose weight, and did some online research about this test.

There's no information on their website about DNA Slim - their site only talks about DNA Fit. I guess some smart marketing whiz kid decided to re-christen the same test as DNA Slim , presumably because there's more money in weight loss than fitness . Someone needs to tell the VLCC webmaster to update their website !

The seductive message behind the VLCC ad is that every person is different , and that their ability to lose weight is tied to their genes . According to VLCC , their new DNA Slim test will allow people to figure out what method will work best for them , so that they can then adopt this. This is their scientific spiel, and seems like a great idea . However, the reality is that they are selling false hope in the garb of pseudoscience and extremely sophisticated quackery .

The only "scientific research" on their website about the DNA test they offer talks about Stanford University, and some doctor named Kazuko Masuo, but there's no published reference given , which is a major red flag. If this has been scientifically proven, then where are the medical journal articles documenting how and why this test works ?

The weight loss market is a billion-dollar business, and while it’s possible to help people lose weight , most people find it extremely difficult to keep that weight off for multiple reasons . However, every fat person will blame their “ metabolism “ for their fatness. In an earlier generation, the fashionable culprit was the thyroid gland ! Everyone who is fat will talk endlessly about how they put on weight , even though they don't eat anything and exercise regularly . However, if caloric intake is more than caloric expenditure, you are going to put on weight , irrespective of your diet, exercise, metabolism or your genes.

However, putting a scientific spin is an extremely clever marketing move , because every obese person wants something to blame for their inability to shed those extra pounds. And if it’s your DNA at fault, then what can you do about it ( except to perhaps drown your sorrows in a calorie-laden drink about how unlucky you are that you have inherited “fat genes”. )

The great thing about genetic tests is that no one really understands them. There's been a lot of hype about genetic testing after the Human Genome project "cracked the code", and everyone makes tall claims about these tests. After all, isn't DNA the stuff of life ? However, the real life value of these tests is   still unproven, because biology is very complex, and a reductionist approach is too simplistic to work. The layperson doesn’t have a clue that the tests mean – and neither do most doctors. If the DNA test results are attractively packaged in a clever format , it is easy to take lots of people for a long , long ride , and to make a lot of money in the process . After all, no matter what the test results are, the advice is going to be the same stuff we already know – eat healthily and become more
active !

Putting on weight is a multifactorial problem , which is impacted by many things . While it's true that heredity impacts obesity, there are lots of other things as well , such as your diet , how much you exercise and how disciplined you are. None of this can be summarised in a DNA test ! However, even if the test has no scientifically validity,  it will become extremely popular , because it's being marketed so cleverly , and VLCC will continue happily smiling all the way to the bank. VLCC is not the only one, of course, and the GeneSupport lab in Pune also offers The Weight Loss Panel, a genetic profiling test . My prediction is that we are going to see lots of these tests from many companies who are going to hop on this bandwagon, and help lots of gullible people lose some money !

Why Well-Informed IVF Patients Irritate some IVF Doctors

It’s not uncommon to see doctors getting irritated with patients who know too much. Thanks to the Internet, it’s now possible for infertile patients to conduct research on their illness and treatment options. Many infertile women spend a significant amount of time scouring the net, hunting for the latest information and the best doctor. Since they spend so much time doing online research, they tend to become quite expert on their particular problem.

The Stark Truth

Armed with all that information, when they discuss their treatment options with their doctor, they also expect to be treated as well-informed patients, so they can have an intelligent discussion. The reality is far removed from their expectations; most doctors perceive them as threats. When a patient starts asking too many questions, it makes doctors uneasy and anxious. They wonder why the patients are asking so many questions of them and whether it’s because they don’t trust him.

A Waste of Time?

Some doctors go one step further and tell these well-informed patients that they are only wasting their time sourcing information from the Internet since they don’t have the knowhow to identify which information is accurate and then make sense of it. They tell their patients that its far better that all this is best left upto him, who will make the right decisions for them; as he is the expert with years of experience behind him.

Mocking Patients

In my opinion, this is nothing but an archaic paternalistic approach; unfortunately a number of doctors are very comfortable with it. When a patient starts asking any questions, they eke pleasure out of the situation by “putting him in his place”; they do this by asking the patient very complex technical questions, which the latter obviously would not know the answer to- in effect, this becomes a kind of mockery they use to slight the patient. They freely use medical jargon and this becomes their way of emphasizing their superiority. It’s their way of letting the patient know exactly who controls the reins in the room.

Adding Fuel to the Fire

What’s interesting is the fact that many family members worsen the situation; they dissuade patients from sourcing information online as they feel that “half knowledge is dangerous”. Their other fear is that if they appear to be a “know-it-all” when they visit the doctor, it may antagonize him. This attitude does nothing either for the doctor or the patient. The truth is that a well-informed patient:

• Can form a partnership with the doctor
• Is much easier to treat
• Has realistic expectations about his/her treatment

Time to Look for another Doctor?

If your doctor gets irritated when you ask questions, that's his problem, not yours ! Doctors should treat expert patients as valuable allies, who can help them learn about the patient's perspective. If you find your doctor starts getting upset when you try to have an intelligent discussion with him, this may mean he suffers from an inferiority complex, because he is not willing to engage with you as a respected equal, and you might be better off finding another doctor.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

How to protect yourself from unethical doctors - a guide by Dr Sunil Pandya, my teacher

When you see a doctor for the first time pay attention to the time and effort he devotes to you. 

A friendly and cheerful attitude, concentration on what you are saying, the making of copious notes whilst he listens to you are encouraging findings. 

On the other hand, the doctor watching the second hand of his watch as he sees you, handling innumerable telephone calls whilst you are trying to narrate your woes and the termination of his consultation within minutes of your arrival are disconcerting warning signals.

Beware of the doctor ordering a multitude of tests after a cursory examination and of one insisting that you get them done at a particular centre.

http://www.financialexpress.com/article/healthcare/cover-story-healthcare/is-it-truly-test-worthy/97883/

Another red flag is doctors who demand cash payments and do not give receipts. Doctors who are crooks are willing to cheat the government are quite likely to cheat you as well  !

Embryo Transfer vs Embryo Implantation - The Facts

Even though Embryo Transfer and Embryo Implantation are entirely different, many IVF patients are often confused between the two. The former is a medical procedure wherein the embryo is transferred to your uterus using a hollow, plastic tube called an embryo transfer catheter. On the other hand, Embryo Implantation is a biological process which occurs in the reproductive system.

These two are different, however both are related; this is because, in a successful IVF cycle, the transferred embryos will implant and result in a pregnancy:

• Embryo Implantation- During an IVF cycle, the doctor transfers the embryo into your uterus; here it develops into a blastocyst and embeds itself into the uterus lining. Since Implantation is an in-utero biological process, the control switch is in Nature’s hands and not with the doctor.

• Embryo Transfer- This is a mechanical procedure; how well it is done definitely depends on the skill and experience of the doctor.

Once the Embryo Transfer (ET) has been completed, the excruciatingly lengthy 2 Week Wait (2WW) starts. During this time your mind plays all kinds of games with you and the only thought on your mind is about what is happening to your precious embryos in your uterus. You wonder whether they are being properly nourished are safe and growing well.

Understanding the Implantation Process

This involves 3 steps:

• Apposition
• Adhesion
• Invasion

All these steps are based on different hormonal and molecular signals in the uterus. Since it’s a biological process, no external control is possible. It’s also important to understand that stress levels, diet or physical activity don’t have an impact on it. You will be given hormonal therapy; this prepares the uterine lining for implantation, however, we cannot control the process or guarantee implantation.

The Genetic Abnormality Factor

It’s not possible for any doctor to pinpoint the complex mechanisms involved in this process and hoping and praying are the only things we can really do. It’s only after the 2WW (once you get your HCG results), that you know whether the embryo implantation has been successful or not. There are times when the embryo fails to implant. It’s not always possible to identify the reason for a failed embryo implantation, in most instances; genetic abnormality in the embryo is the cause.

Maintain Realistic Expectations

In most instances, these defects are very subtle and cannot be diagnosed even with the use of sophisticated modern genetic technology such as CCS (comprehensive chromosomal screening). However, we do know that the eggs of older women are at higher risk of having genetic defects due to the aging process.

It’s important for patients to understand that when embryos fail to implant post the transfer, it’s not an indication that the IVF clinic is incompetent or that your uterus is “rejecting” the embryo. It simply means that the implantation isn’t a sure-shot process, and having realistic expectations of IVF success is vital.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

Male fertility: Here are some Hard Facts, go Figure

Infertility is on the rise, and a larger number of men are open to the idea of getting treated for infertility. There was a time when infertility was considered to be only a woman’s problem, but today, we know this is not the case. Almost a tenth  of all Indian men have some type of infertility issue, and so it’s not surprising to hear different “scare” stories that surround sperm health.

There are concerns over the influence of environmental chemicals and pollutants on male fertility. The only thing I say to my patients who have such queries is- using a non-stick pan to toss a breakfast egg, driving in a car that has been newly upholstered or using a sunscreen to protect your skin is not realistically linked to poor sperm quality. There are a number of studies which are being carried out, but none of them are really conclusive at all. None of these products are likely to be the root cause of issues for couples who are desperate to have a baby.  However, bad habits such as smoking and excessive drinking or even being overweight can impact the motility or quality of a man’s sperm.

Let’s bust the  myths which masquerade in the garb of facts.

#1 Cooling your testes will improve  Sperm  production

While it's a fact that your testes function better when they are cool ( which is why they are located in the scrotum) , cooling your testes will not improve sperm production, sorry. Ingenious andrologists have even devised cooling underwear, but these do not help at all. Also, please do not worry about  that occasional sauna you take - it will not "cook" your sperm !

#2 Foods and Supplements Can Improve Your Fertility

Sadly, this is a myth.  Antioxidants , Vitamins C & E, zinc and folate  are often prescribed by doctors who are trying to be helpful, but they are unlikely to improve your sperm count and motility , sorry.  In fact, well-meaning wives will stop allowing their husbands to eat fast foods, because they feel that these will harm the sperm. This just ends up making the poor man's life even more miserable.

#3 Seasonal Sex Creates  Stronger ‘swimmers’

There is no scientific basis for this belief.  Humans are warm-blooded mammals, and are fertile throughout the year. There is no connection between the time of the year you have sex and the chances of conception.

#4 Store up your sperm and have sex only during the "fertile time"

The approach of abstinence and consciously retaining your seed in order to increase the chances of scoring at least one direct hit is a flawed theory. Research has shown that sperm motility deteriorates in proportion to the time it is left in-situ. Thus, infrequent ejaculation can in fact contribute to infertility.

We advise   patients that they should have sex a minimum of 2 times a week – and the more the better. You cannot “run out of sperm”, so please don’t worry ! While the semen volume will decrease with repeated ejaculation, as long as the sperm are being deposited in the vagina, this will not affect their ability to fertilise the egg – and “fresh” sperm are motile and raring to go !  Frequent ejaculation clears-out old sperm, so that your semen now has more potent, new ones.

As you can see, there are a number of myths surrounding male infertility.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

Creating Trust between Funders and Founders

This post is based on my experiences as a newbie angel investor

When founders find funders who believe in their mission, and are willing to back them with money and support ; and when investors find entrepreneurs who are passionate , and are willing to listen to the advice and guidance which they can provide, this can make for a winning combination. The right mix can create magic !

The key ingredient in this relationship is that of trust, which means the founder should believe that the funders have his back and that they will support him through good times as well as bad . Similarly, the funder should believe that the founder is able to focus on the big picture;  is willing to keep the company’s interests foremost during his actions ; and understands the importance of listening to multiple perspectives, rather than obstinately doing what he thinks is right , without bothering about respecting anyone else’s views.

https://www.linkedin.com/pulse/creating-trust-between-funders-founders-dr-malpani?trk=pulse_spock-articles

Spirituality in patient care

While doctors are usually very good at taking care of a patient’s physical needs , we usually neglect to minister to our patient’s desire for spiritual comfort. This is a deficiency we urgently need to rectify, because a patient’s spiritual health can have a significant impact on how they cope with their illness. The idea that spirituality can help to heal is very old, and traditional cultures have always relied on medicine men, witch doctors and shamans to use spiritual interventions in order to cure illnesses, often with remarkable results. After all, it is through both the channels of medicine and religion that humans have grappled  with the common issues of suffering, despair, and death , when confronted with an illness.


Here's what doctors can do to , in order to respect the patient's spiritual beliefs
http://www.docplexus.in/articles/c0b70a17-7fc1-4016-a44b-420385515a23/-spirituality-in-patient-care-looking-at-the-bigger-picture

The Invisible Losses of Infertility

When infertile couples come to us for treatment, they are full of hope and we are also very positive in our approach to consulting and treating them. However, there are times when fate (is there such a thing at all?), has something else in store for them. Though we have pretty high success rates at our clinic, there are times when nature takes its own course and despite what we do, our attempts fail. Some couples go through multiple failed IVF cycles and are unable to conceive.

Whilst it doesn’t appear that these patients have actually lost anything tangible (in the physical sense), a number of people who face involuntary childlessness tend to suffer a very deep sense of grief and loss; this is something most people around them are oblivious to. Family and close friends don’t recognize that when you have to face the fact that you aren’t going to have the baby you wanted, you can feel very isolated.  For many women, this grief can be very intense and overwhelming.

Facing the reality that they are not going to be able to have children, can be heart-breaking to say the least; regardless of whether a couple is attempting to conceive a child in the bedroom or with the help of IVF.

The Invisible Losses

The loss that is linked with involuntary childlessness is far deeper than just not being a father or mother, since they also lose:

• The chance of having their own biological family
• Celebrating milestones with their children- their first steps, their first day of school . This is something most of us who are fortunate to be parents take for granted
• The chance  to see their kids playing alongside their nephews and nieces

To make matters worse, many  suffer from the additional burden of  guilt, because they feel they have failed in giving their own parents a deeply desired grandchild.

 When Grief Strikes

For most women who face IVF failure, realizing that they aren’t going to be able to have a child doesn’t just strike them out of the blue. Many patients go through various  investigations and treatments(on account of the nature of their infertility issues) and for them, the reality of the situation becomes more  of a very “gradual process”. As they  go through multiple failed cycles and losses, they recognize that their chances of  becoming a mother are fading  before their eyes.

Many couples try for years before they finally  decide that enough is enough and that the  process was becoming  just too painful and difficult. People who have not going through IVF treatment, can’t even begin  to comprehend the emotional and physical  torment that an IVF patient  goes through and how their mind, body & spirit starts buckling with every failed IVF cycle.

When Grief Fades Away

Anyone who has trodden this path and walked over these brambles will also tell you that over time, the cloud of grief does lift. It’s important to give yourself the time and scope to get the grief out of your system.

• Understand that it’s okay to go through phases that are bad; once  you tell yourself this, that becomes the start of the healing process
• Communicate with friends and family or go to a counselor
• Take some time out and do things that will keep you occupied and distracted
• Remember that your body needs to recover, and be kind to yourself
• Get the negativity out  of your system

Hope on the Horizon

For many women the psychological loss of the life they thought they were going to give birth to becomes the biggest invisible loss while dealing with involuntary childlessness. When it comes to grief, there are no rules and every woman’s journey is unique. You may not be able to get  rid of grief completely, but with time, the pain will lessen and you may just  find that there are other options  before you.

We do have a number of patients coming back to us enquiring and wanting  to know more about  options such as surrogacy and adoption- and in most cases, that becomes the start of a brighter journey for them.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!