Saturday, November 14, 2015

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 so that I can guide you !


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