Why do doctors abandon a patient after a failed IVF cycle?

Every patient does an IVF cycle with the hope that it's going to work, even if they understand that the chances of failure are higher than the chances of success. In their heart of hearts , they hope that they're going to be the lucky one this particular time, which means that when the cycle fails they often go to pieces. This is the time when they require the most support and hand-holding from their doctor, but typically this is the time when the doctor abandons them. The senior doctor is never available for a consultation, and no one is willing to talk to them or explain to them what went right; what went wrong; what they learned from the cycle ; and what they can do differently can do next time.

Patients resent this. They feel cheated because they feel that the doctor just wanted to extract money from them, and now that they have paid their fees, he is no longer interested in them.

It's easy to understand why IVF doctors don't want to talk to the failures. It's no fun having to console a patient who's crying , or who's asking a lot of tough questions. This can be quite embarrassing and uncomfortable for the doctor, because often the patient blames the IVF doctor for the failure. This is especially true when the patient has not been properly counselled; or when most of the treatment has been delegated to assistants and juniors.

The reality is that this is the time when the patient needs the doctor the most. This is when the doctor should step up and proactively reach out to patients , to help counsel and guide them in their darkest hour.


Is your doctor evasive after your failed IVF 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 !

How infertile patients can find the right answers by listening to their heart

Lots of our IVF patients are mature professionals . They are extremely intelligent, and understand all the medical details and minutiae of an IVF cycle . They understand that their chances of getting pregnant are slim because of their age, but even if they know that the odds are stacked against them, when their IVF cycle fails, they go to pieces and they find it very hard to go back to normal and pick themselves up.

The next question often is, "Okay, doctor, my IVF cycle has failed. What do I do next? Should I consider using donor eggs, should I adopt , or should I just let it be? I understand that the odds are stacked against me if I try with my own eggs, but it's very hard for me to come to terms with the fact that I may need to use donor eggs."

My answer to this question is - the right solution cannot come from me - it has to come from you. However, it cannot come from your head, it has to come from  your heart and gut. One of the problems with people who are intelligent is that while their brain works extremely well, they often don't have the ability to listen to their heart and interpret its signals . They tend to switch off their intuition, because they're so focussed on listening to what their brain has to say. They try to extract information from the intellect , and don't take advantage of all the clues which their body is providing them with.

This is why tools like meditation are so important. Mindfulness creates self-awareness, and allows us to listen to the answers which are bottled up inside us. It's not a question of being spiritual - it's just acknowledging the reality that the right answer is different for every person, and the answer is locked up inside you.

You cannot find the right answer from an external source, and while a doctor may have lots of medical expertise, he cannot provide you with bottled solutions. One size does not fit all, and you need to learn to respect your gut to find your own pat.

The problem is that it takes time for these answers to well up from within; and it takes time for you to listen to these answers, especially when this is something which you are not used to doing. But you can't hurry this up ! It's not like saying, "Okay, I have to study for an exam and then I'm going to pull an all-nighter and cram in all this information."  While your brain is capable of working overtime, your heart has its own pace, and you can not make it run any faster. The head works much faster , as a result of which the heart is often left behind, but there is much more personal authenticity in the messages the heart provides - you just need to still your head to be able to listen to these.

The heart takes longer to provide its messages , and we need to respect this. Both answers are equally valid, and they both carry a lot of wisdom. The language of the heart can be hard to understand, especially when you are hurting on the inside ! When you are looking for solutions, you want the doctor to tell you what to do , because it's very hard to make some of these decisions when you're crying. But there is no shortcut for this. Patients need to learn these skills and become emotionally resilient and find the inner strength to carry on within themselves.

The good news is that the brain of intelligent people can learn the capacity to listen to their heart. This is one of those one of those lifeskills that you need to master , because  your life is going to be full of ups and downs. The reality is that this crisis in your life - this failed IVF cycle - will also pass, and if you allow your brain to listen to your heart, you will emerge from this crisis even stronger , and even more capable of dealing with whatever problems life will throw your way.

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

What was your embryo quality - the key questions I ask patients after a failed IVF cycle

When I do a consultation for a patient who has failed an IVF cycle elsewhere, I ask them two basic questions:
1.  "Give me your treatment summary", and
2. Show me photos of your embryos. 

This is invaluable information, which allows me to learn from the failed IVF cycle, so I know what to differently the next time, and this improve their chances of having a baby by tailoring the treatment to their needs.

Often, the answer is - "We don't have these details", and "We weren't given any photos".

I ask them "Why?" and the standard answer is, of course, "Because the doctor didn't give them."

Then, when I ask, "Why didn't you ask for this basic medical information?" the response is, "We were not aware that we needed to get these details, and that IVF clinics provide embryo photos. "

I really don't think this is an acceptable answer in this day and age.  When patients are spending so much time, money and energy on doing an IVF cycle, the least they can do before starting such expensive treatment is to do their homework and find out what's involved in an IVF treatment, and what a good IVF clinic does. The internet makes is exceptionally easy to do so, so there's no excuse for such laziness.

The reality is that all good IVF clinics provide embryo photos to document that they've provided high-quality medical care. If your IVF doctor says he does not provide embryo photos, this is a red flag, and you should definitely find another clinic, rather than get stuck with poor-quality treatment, and reduce your chances of getting pregnant.

Please make sure you don't make this common error which you will regret later, because you will never be certain as to whether the cycle failed because you received poor medical care.

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

Menstrual myths and infertility

Infertile women harbour many misconceptions , and a common one is about their menstrual flow. The  menstrual flow can vary considerably from woman to woman, but most fertile women don't bother about it . Infertile women , on the other hand, are obsessed about their menstrual periods, especially when they are scanty or heavy or early or late. They forget that there is a lot of variability in biological systems, and many believe their infertility is a result of their menstrual flow being abnormal.

 The problem is that they can't see their eggs, sperm, or their fallopian tubes - all they can see is their menstrual flow, which is why they start imagining problems with every minor variation. Even normal variations get magnified, because their minds plays all kinds of games with them.

A common problem is that many infertile women believe that their infertility is a result of their menstrual blood being dark/black in colour. They think that this dirty, black discharge is a sign that their uterus is full of bad blood, and this is what is stopping from getting pregnant. This is why they go to a doctor, and ask them to "clean " their uterus, by doing a D&C or a hysteroscopy ; and this is why there are so many websites which sell herbal tampons to infertile women, to help them to make their uterus "strong and clean".

However, the reality is there can't be any such thing as a dirty uterus !  The reason for the dark menstrual discharge is simply that when the menstrual blood remains in the vagina for some time, the acid in the vagina converts it into a black pigment called acid hematin, which is dark in color. The woman then misinterprets this as a symptom of having a defective and damaged uterus, which is preventing her from getting pregnant.

A similar myth causes them to worry when their flow is scanty, because they think this means that their uterus lining is "weak" and will not allow the baby to grow in it; or when they have spotting, because they feel this means that the uterus lining is defective; or when they pass clots, because they feel this means that the uterus is breaking down every month.  Doctors need to sit down and explain to patients that there is no correlation between menstrual flow and fertility, and that a lot of these variants are seen in fertile women as well.

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

Why doing hysteroscopy routinely prior to IVF is a bad idea

Many IVF doctors do a hysteroscopy routinely prior to doing an IVF cycle. Their justification is that a healthy endometrium is important to allow embryo implantation and if there is a problem within the uterine cavity, this will reduce IVF success rates by reducing the chances of implantation. Since it's such a simple procedure, then why not do it routinely for everyone before every IVF cycle , to increase the chances of success?

The truth, however, is that this is not a very sensible approach from a patient's point of view. It's good for the IVF doctor , because he just needs to use a check list and mindlessly order the procedure routinely for every patient who comes to them. From their point of view, hysteroscopy is " minimally invasive" , minor surgery. But for a patient, not only is it an additional expense, the very fact that they're required to go into the operation theater can be extremely stressful !

This is why a hysteroscopy should be used selectively , only for patients where the HSG or the scan shows an abnormality. The fact is that for an asymptomatic patient where the endometrial lining is thick and trilaminar  on the vaginal ultrasound scan, the chances of picking up a problem during a hysteroscopy are so low , that it's not justified to subject the patient to a surgical intervention, no matter how minor it is. This is surgery which is likely to provide a very poor yield . Of course, the doctor can justify it by saying that we have now proven that your uterine cavity is normal, but when we can get the same information with a nonivasive ultrasound scan, then is it fair to subject the patient to unnecessary surgery ?

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

The difference between ovarian reserve and egg quality

Most young patients who have a good antral follicle count and a normal AMH automatically assume that they will have good quality eggs , and therefore good quality embryos. However, the reality is that, while this is true for most young patients, this is not always true . Thus, every once in a while we will see young patients who have a good ovarian response, but whose egg quality is poor. They ultrasound scans show their follicular response is good, and their E2 levels rise properly, but when the embryologist checks the eggs in the IVF lab before doing ICSI, he finds to his dismay that they are of poor quality. There is a high proportion of immature eggs ( GV and M1) ; or they look abnormal ( they have an abnormal zona or their cytoplasm is granular and dark).

Unfortunately, poor egg quality is not something we can predict in advance . Eggs are microscopic , and we can only check their quality eggs after doing the egg collection and seeing how the eggs
look ; and whether they fertilize in the lab or not.  Ultrasounds scans only allow us to look at follicles, and while most mature follicles will contain good quality eggs, this is not always true. Thus, we will have patients with poor ovarian reserve who are poor ovarian responders, who end up producing beautiful blastocysts which become gorgeous babies; and we will also see patients who have lots of follicles, but whose eggs never become blastocysts. 

This is invaluable information , which teaches us more about the functional competence of the egg, but short of actually doing IVF, there is no way we can get this information. While the AMH test and the antral follicle count are useful tests, they are indirect markers for ovarian reserve , and do not allow to predict egg quality for the individual patient. Thus, poor egg quality is often one of the reasons for what was called "unexplained infertility" before we had a chance to look at the eggs.
This only serves to emphasise the fact that IVF can provide  important diagnostic information for infertile couples.


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

Genomic analysis in IVF - is it of any use ?

There is a lot of hype about how genomics is going to revolutionse IVF . Using all the basic biological information which our genes provide, along with all the insights which big data analytics provides , powered with artificial intelligence , IVF doctors will be able to take better care of  infertile patients.  They will be able to provide "personalised precision medicine" and this kind of tailoring is supposed to help improve IVF pregnancy rates.

While some of this maybe true , I think there is just too much hype as well.  The idea of analysing genomic data for providing predictive analytics to help you remain well is seductive and logical, but the truth is that the actionable advice which you can give by analyzing the patient's genome is very limited. In fact, the advice which you give the patient after a genomic analysis is pretty much the same advice your IVF doctor would give you without even doing the test !

While genomic analysis looks very impressive ( for example, the ERA, or endometrial receptivity assay has become very popular to analyse "failed implantation" in many IVF clinics ) the fact is that most IVF specialists do not understand the results; and these really don't change the treatment which the doctor can offer.

However, the advice looks a lot more impressive when it comes on a computer print out, which uses a lot of esoteric and exotic names .  And perhaps you are more likely to take it more seriously when you have spent a lot of bucks to get this fancy report. Forget about the poor patient, most doctors don't understand this either - it's all gobbledygook to them as well !

We need to cut through all the clutter and ask ourselves, "What real life difference is this genetic analysis going to make to patients and doctors?" While it can be profitable ( for the doctor , who orders the tests, and the company which markets these tools) to do the analysis , let's not forget that it comes with a down side as well.  While the genomic companies are happy to market their new toys by highlighting success stories, most of these are anecdotal and isolated.  No one has been able to prove that they provide a worth while return on investment.

I think it's important to understand that, yes, we can input all this data in and we will get an output in the form of glossy, colorful reports , but how useful are these results?  We forget to do a cost benefit analysis, and think about what the costs would be if we applied these tests across the board to everyone ( which is what the genomics companies want us to do !)

The impact for the patient can actually be negative , because she wastes a lot of money on these expensive tests, which she really didn't need to do the test in the first place.

All data needs to be interpreted in the clinical context , and the role of the doctor remains extremely important. After all, it's the doctor who's going to tell the patient - this is what you need to do with the information . The problem will all these tests is they promise to provide a crystal ball , but the fact is that it's a very cloudy crystal ball , and the signal to noise ratio is poor.

 While it's great to have this data on a research basis I don't think it's really fair to ask patients to pay for this, because the impact it will have on their health is still unproven. Part of the problem is we all suffer from shiny object syndrome. It's great to talk about the future and how it's going to become a lot better with genomic analysis and smarter computers. We all want to play around with gee-whiz technology , and so do physicians.

I am not a  Luddite, but it's the doctor's job to convert this data into wisdom for the patient who is sitting in front of him. Translating  this research data into clinically useful decisions for the individual patient is going to take time. Until we get there , the companies should acquire this information on a research basis , but it's unfair to charge patients for a clinically unproven service .  The danger is that once patients realise that the information they get is of limited value, everyone will get disillusioned, and digital health startups will lose their credibility, without being able to accomplish what they set out to do .

Fed up of all the expensive tests your doctor is ordering for you ? Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Will an assistant do the consultation ?

I received this email

As we have experienced in other hospitals that the junior Dr's attend the patients on 1st visit. Is it the so in our hospital. We would be grateful if we get your consultation to us as we are travelling from far off place to mumbai.  

This is a common worry which lots of patients have. They travel long distances to get an expert opinion from the senior IVF  consultant, but usually end up being seen by a junior assistant who practises cookbook medicine and uses a checklist mindless protocol to order lots of pointless tests and scans. This can be very frustrating for patients.

This is why we don't have any assistants in our clinic  and I do all the consultations myself. We try to do as much as possible by email to save the patient time and money. Since I answer all my emails myself, this is much more efficient and productive. We feel it's s best for patients to do their tests locally. In case there is a problem, we can fix it before they come to us for their treatment.

This option saves them you time and money, so we can start with the treatment directly when they come to us.

Reproductive myths and misconceptions

I got this email today.

Once I masturbated thrice a day for pleasure and at night did intercourse with my wife and now she is pregnant I am worried that after three ejaculation the quality of my sperm will be low or stressful sperm and can cause birth defects in my baby.Please guide me should I abort this baby.

This patient's worries  are completely unfounded, and I reassured him that there was no cause for concern. After all, the fact that his sperm fertilised his wife's egg and got her pregnant means they were strong and competent !

We may make fun about how poorly informed he is, but his worries would have caused him to spend sleepless nights - and there was no one he could ask for help. The internet allows patients to reach out to experts for help and reassurance !

Donor Egg IVF Guide

Today, IVF is a very popular infertility treatment, with very high success rates as well. However, if a woman has diminished ovarian reserve, it can be a hurdle for her to get pregnant even with  IVF, without some additional help.

IVF with donor eggs is the ideal treatment for women with few eggs or poor quality eggs, who want to get pregnant. Here is our donor egg IVF guide. It will give you answers to the who, what, why and how of this procedure.

Who would require an egg donor?

Conventionally, donor egg IVF treatment was used for women who had premature ovarian failure .  This isn’t a very common condition and in  premature ovarian failure ( POF) , the woman’s ovaries stop functioning as there are zero egg reserves.

The commonest group of women who use donor egg IVF today are older women, because they have poor ovarian reserve. In these older women, even if there is some ovarian function , the egg quality and quantity are poor, which means the chances of getting pregnant with their own eggs if poor. These women have to rely on donor egg IVF to become pregnant. With age, a woman’s eggs also age and they aren’t fit to be used in the IVF treatment.

If you have gone through a number of failed IVF cycles, it can be an indication of poor egg quality and the IVF doctor may recommend that you consider opting for donor egg IVF. Women who suffer from certain genetic conditions like sickle cell anemia (which can be passed on to your child), can also opt for donor egg IVF.

Do I have to get tested?

Before you start with the treatment, it’s important that you get a comprehensive medical evaluation; this will tell you whether your body can deal with all the demands of pregnancy. In the event that any abnormalities are noticed, these can be corrected before you start with your IVF treatment. When you opt for donor egg IVF, you won’t have to take fertility injections, which means the treatment is very easy and stress-free.

We have an active donor egg IVF program . Read more at http://www.donoreggs.in/

Not happy with the attention you are getting from your IVF clinic? 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!

Cost of IVF in India

Most infertile couples who are considering doing IVF have some common concerns and queries about it; one of the major concerns is the cost of IVF in India. They know that it’s going to cost them a pretty penny and they aren’t wrong. IVF was never an inexpensive treatment and in many cases, this factor acts as a deterrent for some couples. Just like any other treatment, IVF costs differ from one clinic to the next. Let’s understand a little more about what is involved in this treatment and how its pricing works.

At the Malpani infertility Clinic, a complete IVF cycle costs only US $ 4000.
This includes all medical treatments and procedures. Medicines would cost about US $ 1000 more. However, the cost of medications can vary, and depend upon how many injections you need for adequate superovulation.

 Included services in our IVF cost:

    Ovarian stimulation monitoring
    Anesthesia for egg retrieval
    Egg retrieval procedure
    Fertilization and culture of the eggs
    Embryo transfer procedure
    All physician, IVF lab, and facility fees associated with in vitro fertilization

There is NO extra cost for doing ICSI or a blastocyst transfer !

Excluded services - not included in our IVF costs:

    Pre-IVF screening tests
   Blood tests ( such as E2 levels)
    Embryo or sperm freezing or storage - these are optional services


Why is the Cost of IVF so High?

The fact to keep in view here is that most couples may not get pregnant in the first cycle and may have to go through multiple ones before they meet with success. This is what escalates the cost of IVF On the bright side, this cost is still far lower than what it costs in many countries across the globe. Of course , there could be a variation in cost based on individual treatments, the type of fertility drugs used and whether advanced treatments like embryo freezing, ICSI and egg or sperm donation are used or not.

So the next logical question- If the cost of IVF in India is so high, then why do people opt for it? The answer is pretty simple really…

India now has the latest medical technology and also has fertility specialists with impressive credentials and skilled medical staff; this has significantly improved the way IVF is performed in India and the success rates are very high as well. It’s hardly surprising that people from all over the world come here for their treatment.

IVF success rates are inversely proportionate with the age of the woman. The lower the age, higher the success rates and vice versa. However, IVF success rates in each cycle are much higher compared to that of treatments such as IUI. The greater the number of cycles the woman undergoes, the higher the chance of success.

Not happy with the attention you are getting from your IVF clinic? 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!

How IVF doctors take advantage of a patient's ignorance

A patient sent me an email about her failed FET ( frozen embryo transfer ) cycle.

I asked her to send me photos of the embryos which were transferred, and she emailed them to me.

Now it's obvious to the practised eye that these embryos are all dead. The cells are dark, which means they have not survived the thawing process ( perhaps because the embryologist was not skilled ). However, the poor patient has no way of being able to know this, and she feels her cycle failed because her uterus "rejected" her embryos and has been advised by her doctor to consider doing surrogacy !

Knowledge is power, and patients need to learn to do their homework if they want to get the best medical care. Now this does not mean that patients need to become embryologists ! There are lots of free resources available ( for example, you can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos)   and these can help patients to demystify the IVF treatment process

IVF vs. IUI - which is better ? Cost and success rates

It’s not uncommon for patients to be uncertain about whether they should opt for IVF (In Vitro Fertilization) or IUI (Intrauterine Insemination). In most instances, their own doctors add fuel to this fire of confusion. It’s not difficult to figure out why- Gynecologists don’t perform IVF, but they do perform IUI and it’s not surprising that they aren’t too keen to refer their patients to an IVF specialist.

It’s unfortunate that in their effort to retain their patients, they end up misleading them. Gynecologists claim that IUI has high success rates and advice their patients to continue with their IUI treatment, cycle after cycle, even when they find that they are nowhere close to their end goal. As a matter of fact, many doctors also advice their patients with male factor infertility to do IUI, telling them that all they require is one good sperm to fertilise the egg. However, the pregnancy rate with IUI for men with poor sperm is very poor. After all, the fact that the count is low or the motility is poor means the sperm are functionally incompetent, and will not be able to fertilise the egg, no matter how much it is “washed and processed and concentrated” !

The Tug-of-War

It also means that eventually patients get disillusioned, frustrated and fed up when multiple IUI cycle ends in failure. Not only have they poured a significant amount of money & energy into their treatment, but they have also lost a lot of precious time on these failed IUI treatment cycles. The downside to this entire situation is that this makes them unwilling to give more effective treatments a chance.

There is another side to the IVF Vs IUI coin. Some IVF specialists add to this simmering pot of confusion, by overprescribing IVF treatment. It’s true that for many couples, Intrauterine Insemination is a far less expensive and much simpler option compared to IVF. However, it’s very common for IVF Doctors to coolly overlook this fact and recommend that IVF is the best option. So now, what exactly is the poor patient who is caught in this tug-of-war, meant to do?

The Right Choice

In this situation, the only way to make a smart choice is to look at the pros and cons of both IVF and IUI.  There are some distinct advantages and disadvantages of both, and researching in a concerted manner and being more well-informed will help you reach the right decision. The one major consideration in making this decision doesn’t have a medical angle at all- surprisingly, a number of patients and their doctors tend to overlook that they aren’t taking the time factor into consideration . They get blinded by the fact that IUI is less expensive compared to IVF. 

Though that is a fact, it’s not one that stands in isolation.  IUI also has a much lower success rate as compared to IVF,  and that means a couple will take much longer to conceive using IUI. This is why IVF is a much better option for older couples. Younger couples have the luxury of time and can try out 3 IUI cycles before considering IVF, if the IUI cycles go well. There's little point in doing more than 3 IUI cycles, because after this patients have reached the point of diminishing returns.  Most patients who get pregnant with IUI will conceive in 3 cycles.


Money Matters, or Doesn’t It?

If money isn’t a major shackling factor, I suggest that infertile couples skip IUI and opt for IVF straight away, if they don’t want to have a long and drawn-out treatment to get pregnant.It’s true that IVF will cost a pretty penny, but it’s worth every penny too, as it offers a far higher success rate. If you are questioning the ethics of this treatment decision- the only thing I’d like to say is that the end goal is what matters , and not the path that is taken to reach that goal.

For a number of patients, IVF is the one way to up their chances of having that much-wanted baby and they would rather not spend their precious time and energy on IUI, when money isn’t really an issue for them.

Not happy with the attention you are getting from your  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!

Fresh Vs Frozen Embryos

“Dr, should I opt for frozen embryos or are fresh ones better?” This is a very common question I get to hear from patients who have come in for a consultation. If I had to answer this question a few years ago, I would have unhesitatingly said that fresh embryos are definitely better compared to frozen ones- it’s what conventional medical teaching says. That’s because in the past, when we used the slow freezing technique, a lot of embryos would get damaged during the thawing process, as a result of which fresh  embryos used to have a higher implantation rate (meaning they have a much better chance of actually turning into a baby).

But we don’t live in that time and things are very different from what they were then. In a standard IVF cycle, we superovulate the patient. The downside to this process is that these very hormones that help a patient produce more eggs also mess up her uterine lining; this impacts its ability to be receptive for implantation. It’s one of the reasons why natural cycle IVF and mini IVF are a more popular choice today.

Studies indicate that when you compare the implantation rates of embryos in natural cycles vs superovulated cycles ( using embryos of the same quality), the implantation rates of the former are higher than the latter. This goes to show that patients may actually have higher chances of getting pregnant when transferring frozen embryos in a natural cycle.  This helps keep the lining of the uterus at its optimal receptivity , so that it can allow embryo implantation more effectively.

The Vitrification Process

Earlier, the slow freezing protocol was the only one available for freezing embryos. This wasn’t too efficient and there were very high chances of damage to the embryos during the freezing and thawing process. Even in the best of IVF labs, the embryo survival rates were dismal; this was primarily because the slow freezing process itself caused damage to the embryo. Ice crystals formed within the cells , and damaged the blastomeres. Unfortunately, the damage couldn’t be prevented even with the cryoprotectant chemicals used in the process.

But vitrification came along and changed all that. With this process, we get more than 99% survival rates; in addition, we are also certain that the blastomeres won’t perish when they are thawed.  Of course, it’s vital that this process be handled by a skilled embryologist. This is a significant advance in the field which as completely transformed IVF.


Why Use Frozen Embryos?

One of the major advantages is that we don’t have to now transfer too many embryos in a single cycle.  We have the technology to freeze embryos for our patients and this gives them the peace of mind and assurance that in case they need to use their embryos later, they will find them safe and sound. Today, our patients are more than willing to accept single embryo transfers because:

• They aren’t worried or concerned that they are wasting or discarding their precious embryos
• The frozen thaw cycle is far easier for patients; it is less disruptive and stressful as and we don’t have to do more than 1-2 scans
• They are easier to repeat
• Lesser risk of high order multiples
• Excellent cumulative conception rates
• Much easier on the pocket

Choose the Right Clinic

The one thing that patients should keep in view is that all clinics don’t have the best technology to vitrify embryos. It’s a relatively new technique and only a skilled and experienced embryologist would be able to tackle it well. The vitrification learning curve is very steep and most embryologists end up killing the embryos while they are training to vitrify them.

The only way to ensure your embryos are treated well is to opt for a reputed and experienced clinic that employs a full-time embryologist. It’s also important that the clinic provide you photos of your embryos; prior to vitrification and post thawing.

Not happy with the attention you are getting from your IVF clinic? 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!

Why are so many IVF doctors so irrational ?

Most IVF doctors take pride in thinking of themselves as being scientific in their approach.  A lot of patients also suffer from the same delusion , and believe that doctors who practice modern medicine  are rational, and will follow scientific principles in order to give them the right treatment.

However, sadly, this is not true. While evidence based medicine has become an extremely popular buzz word, the reality is that most doctors still practice eminence based medicine - based either on what they think they know ( when they rely on their personal experience, especially after they have got a few grey hairs;  ) or on an expert's opinion ( after hearing a talk at a medical conference, or reading an article in a medical journal).

Humans are remarkably easy to fool, and this is as true for doctors as it is for anyone else. This is why pharma companies invest so many billions on influencing and manipulating doctors. They lure key opinion leaders ( KOLs) to give lectures, and because these physicians are wined and dined, they're programmed into delivering the message which the pharma company wants to convey. This is often based on biased company -sponsored "scientific" studies, and the doctors in the audience are then quite happy to do what the "authority" tells them to do , because they don't realize how the KOL has been manipulated. In fact, often the KOL himself doesn't realize how he's being manipulated - so that not only does he take doctors for a ride, he gets taken for a ride as well !

It's much easier to rationalize than to be rational, which is why humans will continue to suffer from cognitive delusions, and doctors are not immune to these.

Doctors are surprisingly innumerate. They don't understand probability, and most cannot calculate numbers well at all. They are confused by statistics, and are happy to take mental shortcuts so they can carry on with their primary job of treating their patients. This is why they rely so much on anecdotal case studies, either based on their personal experience, or based on what they hear from an expert. Sadly, this is full of misleading biases.

A  good example is the wide misuse of what a lot of doctors called empirical therapy. This is treatment based on experience , and they can use this label to justify anything they choose to do to their patients.  Does the expert's advice be applied to that particular patient sitting in front of them? Doctors really don't have the time or the energy to be asking some of these difficult questions, and it's much easier for them to take use heuristics and rules of thumb to manage their patients. Fortunately, because most of the patients they see  have common, run-of-the-mill, bread-and butter problems, they can get away with this approach most of the time.

This is also why most doctors are mentally lazy . They just don't have the luxury of time to be able to think or apply their curiosity and intelligence to every patient they see. They are quite happy to order a battery of tests  in the hope that something abnormal will come up. They can then start "treating" this abnormality, never mind whether this helps the patient or not.
 
This is much more convenient for them, and this is why most doctors will not take the time and trouble to take a meticulous history or do a thorough clinical examination. They would rather send the patient off on a wild goose chase by ordering test after test, until one comes back as abnormal ! They can then point out to the patient that they have now finally "pinpointed" the problem, and then proceed to "fix" this.

There are too many patients, and it's much easier for them to take shortcuts, and do what everyone else is doing, or do what the " expert " tells them to do , without applying their own mind. The problem gets worse with time, as they get busier, and have even less time to sit back and reflect about their biases and prejudices.  This is why there are so many IVF specialists in India who prescribe antiTB drugs to all their patients, left , right and center !

The simplest way to counter this problem is to listen to their patients - but ironically, many of them will refuse to do so, because they think their patients are "unscientific" and will not be able to teach them anything !

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

Evobi raises the next round of funding

Evobi Automations Pvt Ltd has received Rs 3.5 crore ($530,000) in angel investment, as the education-technology startup that makes the Bibox tool kit for students looks to expand sales and launch more products.
The Bangalore-based company received the funding from Ravi Krishnamurthy, managing director at Bangalore-based roofing solutions company Shadeflex India Pvt Ltd, and an unnamed investor.
The funding takes the amount the company has so far raised to around Rs 6 crore ($910,000). Its earlier investors include Dr Aniruddha Malpani of Mumbai Angels; Manish Gupta, former MD of Rare Enterprises; and Naren Koduvattat, a former vice president of Infosys.

http://techcircle.vccircle.com/2015/11/17/exclusive-ed-tech-startup-evobi-automations-raises-530k/

I am an angel investor in Brun

I am an angel investor in Brün , a startup which has created a revolutionary low-cost new labor monitoring tool. Its patented technology ensures easy detection of vital signs improving usability while keeping costs manageable.

Brün enables the adoption of best practices in labor management for all tiers of healthcare.

Doctors need to make their patients the stars on their website

A lot of doctors worry about how they will be able to run their own website. While buying the domain or publishing the website and putting up basic information is easy enough to do, how will they generate content? How will they keep their website new and fresh?

I think there is a simple answer to this. The trick is to make their patients the stars on their website. It's  easier for someone who is visiting a website to identify with someone who is very similar to them, and if the purpose of the doctor's website is to reach out and educate his patients, then getting his own patients to talk on his website is the best way of doing so.

Doctors should use their website as a platform for their patient's voices. This content will allow as an immediate emotional connect with your visitors.  This strategy will allow you to generate lots of fresh content all the time - in local Indian languages. You can ask your patients to talk about their disease and the treatment in their own words. You can interview your patient , and upload this to your site.

You can ask your smart patients what they do when they have a particular problem, so that they can share their wisdom with others. You could even ask them to say nice things about your clinic , so that more patients will seek you out.

One of the most popular sections on our website at www.drmalpani.com is the IVF success stories. These are first hand accounts, which our patients contribute, and they provide a lot of hope and guidance to other infertile couples.

IVF doctors are not fortune tellers

One of the commonest answers I'm forced to give my patients is, "I don't know" - and this is the answer they hate hearing. As humans , we all crave certainty. We want answers , because we don't like indecision, and we want to know what the future holds. This is why fortune tellers are so popular, and which is why there are so many talking heads on TV , telling you what the stock market is going to do tomorrow; or what the results of the elections are going to be . Just like we want certainty in other areas of our life, we want it in medicine as well, which is why we go to a doctor , who's supposed to have all the answers, since he's the medical expert.

Then, when I tell my patients "I don't know", they get extremely upset. Even though they know in their heart of hearts that it's an honest answer, that's not the answer which they want. Their first response is, "How come you don't know? Aren't you the expert? Aren't you supposed to know everything? Don't you have years of experience ? If you don't know, then who does? If you don't tell us, then how will we know how to proceed?" I emphasize to them that I don't like having to tell people "I don't know", but if that's the reality, the first thing I need to do is to confront that reality and be transparent and honest with them, so they understand the limitations of whatever I tell them.

I'm a human being , just like they are. I don't have a magic crystal ball. Even though I have professional expertise, it does not give me insights into what is going to happen to the individual patient sitting in front of me. Yes, I can provide them with statistical success rates and averages, but the problem is that these don't apply to individuals. The patient sitting in front of me doesn't really care what happens to the other 99 patients in my clinic - she only cares about what's going to happen to her. This is the one answer which I cannot give her - which no one in the world can give her.

Typically, what happens next is that immature patients who are not happy with my advice will move on to find another doctor who will tell them what they want to hear. The more mature ones will understand that  if nothing else, I'm leveling with them - that I'm being honest, and that I'm going to do my best to help them achieve their goal. Even though I don't know what the future holds, I'm happy to hold their hand and help them to find the answers within themselves, rather than depend upon flawed expertise.

This is why you need to do your homework, so you have realistic expectations from your IVF treatment,, and can get peace of mind that you have done your best by taking the right treatment at the best clinic.

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

Learning from my patients

As medical students, we used to learn from our professors and from our medical textbooks. In clinical practice, we don't have professors to teach us anymore, which is why doctors need to learn by reading medical journals; attending conferences; and from our colleagues.

However, a very important source of learning which we often forget to take advantage of is our patients. All good doctors accept that they learn from their patients all the time. However, you do need to follow a process to maximise what you can learn from your patients.

This is what I do to learn from my patients.

I am respectful and understand that patients can be very valuable sources of knowledge , if I ask them nicely. Thus, it's possible to use patients as unpaid research assistants, and to ask them to look for information on the internet or do a PubMed search. Patients are extremely motivated. Some of them are extremely intelligent and have great business analysis skills, which they can apply to their medical problem as well . I ask them to share the information they learn by doing an internet search with me , so that together we can polish our skills . I do need to guide them in the right direction in the beginning, and provide them with feedback, so that the results of their search become progressively better.

I keep my heart and ears open. There are lots  of inadvertent experiments which occur naturally in real life in clinical medicine. For example, some patients don't follow my instructions ; or forget what I tell them, in which case they end up doing something completely different; or they combine my treatment with alternative medicines.  These are clinical trial where n = 1. When this happens, they're scared and they don't tell me that they forgot to do what I told them; or that they did something completely different, as result of which I never learn from their errors . Sometimes, the outcomes of these variations is better than I would have expected. I have learned to treasure these exceptions and learn from them.

I keep channels of communication open , and tell patients it's okay to make mistakes , provided they share them with me . This way, I can learn from these first-hand experiences of my patients, and use these to tweak the treatment protocols which I offer.

Finally, smart patients will come up with clever hacks, and useful tips and tricks they use in order to manage their IVF treatment When I see that a patient is doing a great job at taking care of herself , I ask them what they are doing - and request them to share their experiences and expertise with me so that I can teach my other patients as well !

How the web creates enlightened patients !

A patient sent me this email.

     I had a  miscarriage(3.5 months) during last pregnancy. Now I am pregnant again(1+ month) and my Dr. suggested me ToRCH test. On based of report she started treatment. While reading on your site I found that positive report not means I need treatment..!!

I was so pleased on reading this email ! In the past, all the medical knowledge was  locked up in medical books and journals. Only doctors had access to this, which means that if the patient fell into the hands of an incompetent doctor, they were likely to get poor medical care.

Today, thanks to the internet , patients can do their homework for themselves, and verify whether the advice which their doctor is giving them is right or not. This will help to protect patients from bad doctors - and will make a good doctor's life much easier !

Another IVF failure story

I got this email from a patient who was at her wit's end.

My reason for Ivf is unexplained infertility. Diag lap& hyst were normal. My amh is on the lower side 2.3. All hormones are normal. Menstrual cycles are regular, perfect 28 days/2-3 days of flow.
No I did not meet the embryologist, the Ivf doc said that out of the 12, they only had 3 embies of 6 cell, grade1-2, with slight fragments on a day 4 transfer.
Iam shocked that at my age I don't even have one excellent quality embryo!!
My 1st Ivf was done in Delhi (step 2014) short protocol, folisurge 150+ menotas 300, stims for 9 days. Retrieved 7 eggs, all fertilised, they do a day 2 transfer at their centre, they transferred 4 embryos of 4 cells grade AB. Cycle negative :(
2& 3 Ivf in Mumbai: renowned Ivf specialist of many years.
Frankly speaking I was never happy with the protocol selection. She used long protocol and stims with menagon 450. I stims for 14 days (2nd Ivf) & 12 days (3rd Ivf).
2nd Ivf: 5 eggs retrieved, 3 fertilised,
3 embryos of 4-6 cells grade 1 with slight fragments transferred on day 3
3rdivf: 17 eggs retrieved, 14 matured, 12 fertilised - and I had only 3 , grade1-2 , 6 cell with slight fragments for transfer!
This doctor advised me donor eggs or surrogate ! I am shocked..
Please help me and give me an honest opinion.

The reason I share these emails I get from patients is to help other couples to analyse the care they are getting more criticially.

Patients are often confused and it's hard for them to find out which doctor is giving them good advice. Did they cycle fail because she has poor quality eggs ? or because the medical care was
poor ?

This is always the million dollar question, and I try to help them find the truth by using a logical framework.

For one, I ask for documentation. I need to see the detailed medical treatment summary as well  embryo photos, before I can provide an intelligent opinion. If there are no embryo photos, then my bias is to assume the care was poor, until proven otherwise. The reason for this is that every good IVF  clinic provides photos routinely and proactively. Not giving these to the patients is a black mark, and a red flag that the care has not been of acceptable standard.

Also, any doctor who tells the patient to use either donor eggs or surrogacy is obviously very confused. These are 2 completely different treatments, and need to be used in very different situations.  This again suggests that the care has not been of good quality, and that improving the quality of care should improve the chances of success.

I am often forced to read between the lines because the documentation is of poor quality, but if a doctor transfers embryos on Day 2, this suggests that they lack confidence in their lab's ability to grow embryos to blastocysts.

Finally , if the doctor transfers more than 2 embryos, this suggests that the implantation rate in their clinic is poor, and they try to compensate for this by transferring lots of embryos at one time, which is poor clinical practise.

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

Why Frozen Thaw Embryo Transfer has Better Success Rates as compared to Fresh Embryo Transfers

Why Frozen Thaw Embryo Transfer has Better Success Rates as compared to Fresh Embryo Transfers
Dr. Sai, Chief Embryologist , Malpani Infertility Clinic Pvt. Ltd.

We often see that patients, who fail to get pregnant in their first cycle with Fresh Embryos, get pregnant in their very next Frozen Thawed Embryo transfer. This is surprising, because we choose the  best-quality embryos for your fresh transfer. So why are the results better with your Frozen Embryos ?

Our success rate in Frozen Thawed Embryo transfers at Malpani Infertility clinic is 62 % as compared to  46 % with a Fresh Embryo Transfer. This is because the Implantation rate is better in a Frozen Thawed Embryo transfer cycle, as compared to a Fresh Embryo Transfer. Let's see why this is so.

Implantation represents one of the important steps for the success of assisted reproduction
techniques (ART)

Its effectiveness relies on three variables:
•    Embryo quality,
•    Endometrial Receptivity (ER), and
•    A well-balanced Embryo-Endometrium interaction

The implantation window is a self-limited time period in which the endometrium has acquired the characteristics to allow for attachment of the blastocyst. This is why optimal, Endometrial Receptivity (ER) is essential for conception in both natural and infertility treatment cycles.

Endometrial Receptivity (ER) is Better in Frozen Thawed Embryo Transfer Cycles

The problem is that in a fresh cycle, the superovulation or controlled ovarian hyperstimulation (COH) we use to help you grow lots of eggs adversely affects endometrial receptivity. This is because of the excessively high levels of estradiol (E2 ) and progesterone (P) during the fresh IVF cycle, which leads to biochemical endometrial alterations. Ultimately, these physiologic changes may affect the success rates of the treatments. These altered hormone levels could mediate an asynchrony between the endometrium and the transferred embryos, leading to an endometrial environment that could be responsible for implantation failure.

The reason for a higher Pregnancy Rate in Your Frozen Thawed Embryo Transfer Cycles is that your endometrium is artificially primed with the use of estradiol (E2 ) and progesterone (P) and the embryos are therefore transferred to an environment that had not suffered the effects of the supraphysiologic hormonal levels that occur during Controlled ovarian hyperstimulation COH.
The endometrial development can be controlled more precisely in a frozen cycle.

Embryo Quality (Frozen Embryos are as good as Fresh)

The quality of the frozen embryos , and their potential to implant is exactly the same as fresh embryos, thanks to advances in embryo cryopreservation technique.  Vitrification ( flash freezing) has been a blessing for all of us, and is the preferred technique for cryopreservation of Embryos worldwide.
Vitrification is the modern, efficient and effective manner to freeze your embryos as opposed to the conventional method of slow-freezing.
Vitrification allows us to freeze your embryos in a glass-like state , to avoid ice-crystal formation associated with freezing. In this manner, damage to your embryo is prevented, and the integrity of the embryo is preserved. Vitrified embryos may be stored indefinitely.

                                           
Before Freezing                                                                                 

    After Thawing

As you can see from the above images, it's impossible to make out which embryo is fresh and which one has been thawed after freezing it for 1 year.

However, it is true that the vitrification technique is difficult to master and involves a steep learning curve. Not all IVF clinics will have such good results. We have now frozen  over thousands of embryos, and have a  nearly 100% survival after thawing.

How freezing your Embryos improve your chances of Conception

Patients get upset when we do not transfer their fresh embryos in their IVF cycle. After all, if we do not transfer, then how will they get pregnant. However, the short-term distress this causes is more than compensated by the higher pregnancy rates we achieve with this policy. If we freeze all your embryos , we can save best embryos for Frozen Thawed Embryo Transfer (FTET) and with the improved Endometrial Reseptivity (ER) in the FTET cycle, your chances of conception can be as high as 80% if we have 4 blastocysts. This is because we transfer only 1-2 blastocysts per cycle, which means we can do 1-4 frozen transfer  for you, thus dramatically improving your cumulative conception rate.

We prefer to  freeze all your embryos (if we get more than 15 eggs) to completely eliminate your risk of ovarian hyperstimulation syndrome (OHSS) . We can then transfer your best Embryos in your subsequent FTET cycle

Advantages of Doing a Frozen Thawed embryo Transfer over Fresh Embryo Transfer

•    Preventing/ Eliminating late- onset OHSS
•    Allowing time for genetic testing ( for patients who need PGD)
•    Restoring endometrial receptivity , thus increasing the implantation and pregnancy rates

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

The poor frustrated, depressed and confused IVF patient

I just received this heart-breaking email from a patient, and I am sure it will resonate with a lot of my readers.

Dear Dr Malpani,
I am writing to you after i have reached a stage in my infertility treatment where i don’t know who is right or wrong, i don’t know if my treatment is going in right direction since every doctor gives their own perspective/ advise on my condition and the line of treatment is completely different.
I am 31 years of age and my case history goes as follows:
1.    I am married since 7 years now ( Nov 2008) in 2012 when we started to plan our family and went for preliminary health checkups, i was told i have Cysts in my ovaries, and that i should get and MRI done. In Oct 2012 i got my MRI Pelvis done and the report suggested endometriosis.

2.    Then started my journey of endless docs visits. The first one was Dr Nalini Mahajan of Nova IVI, who suggested i have Endometriosis and Adenomyotic Uterus and that since i have good egg formation, i should go in for IUI. They stimulated me in one cycle, did my husband’s semen analysis ( 50% mortility) and did IUI which failed. Then the doc told me that i should go in for IVF since laproscopy is not a good option as it might damage the egg quality in ovaries.

3.    I did not relate to this and hence started looking for doctors to get some opinion. Then came Dr Rajeev Bhatia and Dr Indu Bhatia ( Surgeon at Ganga Ram Hospital) who did my first laproscopy and Hysteroscopy in Oct 2013. The discharge Summary is attached. Post that they did 2 IUIs  which again failed. I was told by the patients and the staff in hospital that these doctors are not infertility specialist and i should be contacting some experts.

4.    The next doctor that came was Dr Abha Majumdar ( Director IVF and Gynaecology Deptt, Sir Ganga Ram Hospital), must say a very good doctor to talk to, but since she is very busy shuttling between the hospital and her clinic, harly have time to give proper attention to all the patients. Nonetheless, she saw all my reports, found out that my cysts were not removed in first surgery but only drained out and advised two options, either i take a chance of one cycle of IVF or go in for the surgery again where she will remove all the cysts, try and resume my normal reproductive system and then try IUI. The surgery happened in Feb 2014 and post that two IUIs were done by the junior doctors which again failed. Reports are attached for that as well. The doctor was not available post that to do some counselling and advise further course of action. In the meanwhile i was trying on my own and also reading  a lot about my condition/ its affects etc.

5.    Post all this, i thought may be an IVF is the only way forward and i decided to go ahead with the same in Bourn Hall Clinic where i had just gone to take an opinion, the way docs spoke to me, the serenity of the place, the initial discussion and i was convinced that i will go ahead with IVF here only than going back to Dr Abha since 90 pct of the times its the junior staff interacting with u than the doc herself.
6.    In March 2015, i was told that the hydrosalpings in my tubes have increased which can impact the implantation of embryo hence i need to get the clipping of tubes done, and i underwent a so called lap and hystro procedure again in March this year where they clipped my tubes and then put me on vitamins for a month or so and then did my IVF in June 2015. The prescriptions given are attached as well. 15 oocytes were picked, I had two embryos implanted at day 5 ( Blastocysts) with 3 embroys frozen but unfortunately the IVF also failed. Now i was at my wits end what to do. The doc told me all was fine, guess the adenomyotic uterus has created the problem in implantation of embryos and hence the failure, she dint have any other thing/ observation to share. Please note the doc has also left Bourn Hall and opened her own clinic in Kanpur where she belong to and now Bourn Hall is contacting me to go and have my counselling done with some other doctor who has joined them recently and they are promoting some discounts that they have on the procedure of FET. Bullshit ! They even charged me 30000 to keep my frozen embryos for 6 months.

7.    The IVF procedure really took a toll on my health, i had so heavy and painful periods that i was practically on bed for 2 days. I was thinking what to do that one day i read about Natural IVF in newspaper and Dr Richika Sahay speaking about it and how its less traumatic for patients and all. I thought of going and consulting her, she saw my reports and CDs of Laproscopy procedures done and now she has something completely different to say. She says, till the time the adenomyosis doesn’t reduce in my uterus, the implantation will 90 pct fail since there is no space for the embryo to grow and she says i need to take shots of Leupride Depot for 3 cycles, do my scan and then only go for FET.  She also says that 90 pct of patients with this problem does not conceive and that i should start preparing myself for surrogacy in case my uterus doesn’t react positively to Leupride. I took one dose in Sept, she said my periods might be delayed, but they came on time and when i went for the 3D scan after a month, Dr Girish pandit told me that the Cysts have started to form up again and the adenomyosis is still there. ( Report attached).

8.     Dr Richika then gave me Ovral L for 6 days twice daily saying that this will help reducing my cysts. I got my periods after 6th day of stopping Ovral L and then she did a scan on 2nd say and said that cysts is not too big an issue, since my ovaries are producing good eggs and cysts can be drained in a small procedure and asked me what are we thinking of our FET.  I told her that doc u only said that don’t go for FET till adenomyosis gets better and atleast take 3 shots of Leupride. She even mentioned you can think of getting the FET done in surrogate since Embroys are very precious and are made after a lot of difficulty n all to which i countered her saying that doc one side u r saying that my ovaries are producing good eggs then why should i lose hope so early anf get the transplant done in a surrogate, i would want to get the FET done in myself only to which she said then take leupride for 2 more cycles since taking it more wont help positively at all then get the FET done. Till now i was thinking she is giving me genuine advise but post last discussion, where she mentioned Surrogate i am in a fix again that is she promoting surrogacy or something, why is she losing hope on me too soon when i am still not too old. On the top of it, my periods ended on 1st of this month and till now i couldn’t take Leupride shot since the injection is out of stock everywhere, even Dr Richika doesn’t have it and has said will inform when she receives it, does it not impact the condition, is this not wastage of time now?

I am in complete fix now and don’t know what to do, whom to trust. I have read a lot about you in your blog and i feel that you can give me a genuine advise as to is my line of treatment going in right direction, i stay in Delhi and don’t know is there any doctor left for me to visit with my condition now considering i have tried almost all the reputed hospitals and doctors but has got disappointed only.
Most of my reports of Surgeries and scans are attached herewith, but do let me know if you need to have any other detail, but please help me out doctor.

The major problem is that she has lost trust in all her doctors. They all seem to giving conflicting advice - and what's worse, their advice seems to change every time they see her.

It's hard to be in this poor patient's shoes. She's not going to be able to trust any doctor now ! Why should she expect Dr Malpani to be any better, now that she's burned her fingers with so many different IVF doctors in Delhi !

This is my advice.

Become an expert on your problem. Rather than becoming confused because the  advice is so varied, you simply need to make a list of all your options - both medical and non-medical - and then pursue these one by one. You cannot afford to lose control based on what the latest doctor you see tells you

The philosophy in our clinic is very different. The doctors she has been to seem to be more focussed on identifying problems, and then fixing these, one by one. We prefer bypassing problems.

I feel her adenomyosis and her endometriosis are all irrelevant findings, which will not affect her IVF treatment outcome. Now that her tubes have been clipped, her best option would be to repeat IVF until it works. She does not need either surrogacy, or donor eggs - and there's no need for her to give up either.  Rather than change her uterus or her eggs, she needs to change her doctor, until she finds someone who inspires confidence !

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