Success story after TESE-ICSI

Our success journey from lots of infertility stress to the successful story is not too different from other infertile couples. Dr. Malpani and his team proved to be a strong blessing in our life who not only gave meaning to our life but helped us overcome from lots of stress of infertility.

We got married in year 2008. Life was so smooth, we were least bothered about parenthood in the initial years. But also we didn’t do any planning as we were open for parenthood also. My wife never took any contraceptive pills during the period. After a time span of 2.5 years a thought of entering into a new life of responsibility arose. Thus we consulted a doctor in the nearby city from our hometown. Almost all the reports of my wife were normal. Doctor found slight hormonal imbalances in her reports. We were not too much worried with reports. But the pressure started mounting up when there was no sign of conceiving for more years.

Simultaneously, there was a misconception in my mind as I was treated for hypospadias in my age of 12 . I had major surgeries, and also was having urethral dilatations till the age of 20 years. Although the doctor at that age confirmed my parents that I am not going to have any problem in my post married life & having children too. As I mentioned there was a misconception in my mind thus I asked my wife’s gynec to mention entire tests along with my wife’s test. She mentioned a basic semen analysis test to me. That day was the worst day of my life. It was stunning to see that my sperm count was zero i.e. azoospermia,  but my wife’s reports were normal. My mind was not allowing me to accept the reports of semen analysis. Then with doctor’s consultation I had a FNAC test to make sure whether the tract is blocked or if there are sperms in the testicles or not. In my reports there was normal sperm production in the testes which meant that the tract was blocked. The doctor referred me to Medanta for Vaso-epididymal anastomosis surgery to open the tract so that we could have child naturally. After wasting one more year finally we decided to have surgery in Fortis Hospital far from my hometown. Also, we decided to freeze the sperms extracted during surgery but this was again a strong setback to our thoughts. The surgery was unsuccessful & no sperms were frozen. The doctor told my wife that they found very few sperm and these had defective heads and tails, which is why they could not be frozen. She advised us to use donor sperms instead.

Our hope of parenthood was completely shattered. We both were not at all ready to use donor sperm. My wife was completely in depression n tears. The entire treatment procedure for me & my wife was very tough as I belong to a orthodox family with lots of irritating advices. Travelling all the time to different places for doctor’s examination was very stressful. We had to keep on lying to everyone with new reasons for why we did not have a baby.

Meantime I had lots of homeopathic &  ayurvedic treatments with the hope that the quality of sperm would improve. Then one of my family doctor suggested us to visit Dr. Malpani once. After making up our mind we went to Dr. Malpani clinic in August 2014. It was a great feeling at the first meeting with Dr. Aniruddha Malpani. We have never been so comfortable with any of the doctors throughout our treatment. Dr. Malpani impressed us in the very first meeting with his expertise and encouraged us to be calm and face the situation as it comes. He explained the procedure in a convincing manner and cleared all our doubts. He was very sure that we would not require to use donor sperms. His confidence with TESA treatment touched our hearts.

Finally, with lots of courage we planned to move for treatment in February 2015. When i was admitted for sperm extraction, still that Fortis report polluted my brain as to whether the doctor will get healthy sperm or not. When the doctor came & told us that they have extracted lot of sperms from my testes and 11 eggs from my wife, we had a relaxed sleep that night.

Now we have been blessed with a sweet little baby girl on 28th October 2015 and all that has happened because of motivation and courage provided by Dr Malpani and his team. Both of us heartily want to thank him for making our dream come true.

Thank you ……..

Anurag 


[email protected]

The side effects of googling for information !

Most infertile patients are understandably anxious before starting an IVF cycle. They have lots of worries and concerns ! Will the shots hurt ? Will the hormones cause them to put on weight ? lose hair ? result in moodswings ? How will they manage their job responsibilities while doing IVF ? Will there be side-effects ? Will the treatment be painful ? Will the cycle succeed ? How will they cope if it fails ? And will they be able to afford to pay for it ?

There have lot  of questions, and have read lots of horror stories online, and don't know what to believe.

This is why I prescribe information therapy to my patients. I tell them - Do your homework. Be well read and well informed . This will reduce your anxiety levels . It will help to ensure there are no unexpected surprises , and by clearing your doubts, you will remain in control of your life, because you know exactly what's going to happen next.

However, some patients  believe that searching for information ends up increasing their anxiety levels. Their approach is much simple - ignorance is bliss ! You're the doctor, and I trust you, so you do whatever is required.  Why should I worry about this stuff ? If I start reading about these things, I get more worried and anxious, especially when I read first person accounts which describe how painful the IVF injections are; or describe how they nearly died because of OHSS.

This is a valid criticism, and this is why you need to become a sophisticated patient - someone who understands how to find information which is reliable online. This is why we prescribe Information Therapy - and not just generic non-specific information from a random website which google throws up !

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 to do when you don't know what to do

Infertile couples are often faced with many doubts and dilemmas, and they're not sure how to proceed.  For example, should we use donor eggs ? or donor embryos ? or try once more with our own eggs ?

No matter how much you read, and how many people you ask for advice, you will still have to make the final decision yourself. Also, you may find yourself completely confused the more you read, because there are so many different opinions, and they all seem sensible.  However, how do you know if they apply to your specific circumstances ?

Often patients will ask  investors like me for my advice. It's very tempting to provide them with an answer , based on my experience with what other patients have done when faced with a similar problem; or on what my perceptions are.

However, my favorite answer to this kind of question is - I don't know, and the only way to find out is by doing a thought experiment. Do your homework so you understand your options; pretend that you have selected Option A, and then see how comfortable you are with it. After 2 days, do the same with Option B, and so on. Keep a diary, so you can listen to what your heart is telling you.
 
At the end of a week , you will find what the right answer is for you. Trust your gut !  You will become much more confident that you made the right choice, when you combine both head and heart in your decision making process !

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 !

Orgasms after embryo transfer.

One of the common events which occurs during the two week wait is an unplanned orgasm.  However, this is one of those things which no one ever talks about.

This is partly because women are ashamed and embarrassed about the fact that they've had an involuntary orgasm. Their big fear is that as a result of the orgasm , the uterine contractions will cause the embryos to fall out , and therefore they will not get pregnant.

They fret and fume about this possibility , and are wracked by guilt,  especially when the cycle fails.

However the reality is that these orgasms are common , and are the result of the excessive pelvic vascular congestion during the two week wait after the embryo transfer.  The high levels of hormones cause increased blood flow to the pelvis, and the increased clitoral blood flow sometimes causes an orgasm - often during sleep. It's involuntary and there's nothing much anyone can do about it.

You don't need to worry if you do get an orgasm - your embryos are safe in your uterus , just like a pearl in an oyster , and an orgasm is not going to cause any harm whatsoever.


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 !

Allowing the IVF patient the freedom to make her own decisions

One of the hardest things for me as an IVF specialist to do is to tell an individual patient what to do. This might seem surprising - after all, isn't the  IVF doctor the specialist ? and isn't it our job to help patients to make these decisions ? Isn't that what patients expect - that we will help them to make the right decision by telling them what to do ?

Part of the problem is that I try to be as non-judgmental and non-directive as possible, because I feel patients should make these decisions for themselves. After all the outcome is always uncertain, but if they retain control of such key decisions in their life, they will have peace of mind they did the best, and the treatment process itself will be a happy and a positive one , no matter what the final outcome.

This can be quite challenging for me, because patients in India are still not used to making these decisions for themselves. Many are not sure what to do with this autonomy. In fact, a lot of them get confused and upset when I , the doctor , ask them for their opinion ! They feel that it's my job as a doctor to tell them what to do , rather than ask them for their inputs ! I am sure some of them feel I am incompetent - that it's because I am not very sure as to what I'm doing, which is why I need to ask them for their opinion !

 Thus for example, let's consider a patient who is a poor ovarian responder, for whom I have been able to retrieve only 2 eggs .  I would prefer doing a day 5 transfer, even though she only has 2 eggs, because the value of information I can get from growing the embryos to Day 5 would be far more rather than just going ahead and transferring on day 2.  Thus, if I transfer on Day 2, and if the cycle fails, I will never be sure as to why the cycle failed. Was it because the embryos were of poor quality and they arrested in vivo ? Or was there some other reason for the failed implantation?

On the other hand, If I do a day 5 transfer, I am able to give her much more intelligent information, which can then help her fine tune what to do for the next cycle. Thus, if the embryo arrests in vitro before becoming a blastocyst, then this will cause her short term pain , because I will not be able to do a transfer for her , but she will know on a long-term basis that her major problem is poor egg quality, and that the best option for her next cycle would be to consider using donor eggs. This is invaluable information, which I cannot obtain by any other method.

The reality is that there are not right answers in IVF, and it's important that patients be counseled, so they can make the decision which they feel is right for themselves, because they're the ones who are going to have to live with the consequences of this decision.


It's very easy for me to tell them what to do, and I am sometimes tempted to do so, but I  discipline myself and allow them to decide for themselves. I promise them that I will support them, no matter what they decide. If they are unsure, I tell them to sleep over it. I also promise them that I will never let them make a wrong decision, and I will explain the pros and cons of each option, but that it's in their long-term best interests that they make the decision which their heart tells them is right for them.

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 irrational IVF doctor

When patients fail an IVF cycle and go back to their doctor to find out the reason for the failure, they are advised to do a whole battery of tests ; and lots of additional treatment options are then offered for the next cycle, with the promise that these additional interventions will improve the chances of success. 

Thus, patients are advised to do an ERA ( endometrial receptivity assay)  to check for endometrial receptivity, the explanation being that this test will help the doctor to find out why implantation failed in the earlier cycle. Some doctors will suggest that patients do PGD so that the genetically normal embryos can be identified and transferred. Others will put the patients on empirical therapy with GH ( growth hormone ), with the explanation that this will help the patient to grow more eggs of better quality  ; or will suggest the patient take low molecular weight heparin ( Clexane ), in order to improve uterine blood flow and improve the chances of implantation.

Now there are rational explanations for doing all these tests and taking all these additional injections, but the fact remains that none of these have been proven to be effective.  Thus, low dose heparin can be painful and expensive , and growth hormone costs a bomb, and has never been shown to improve pregnancy rates. But, when patients fail IVF cycles, doctors offer them these additional expensive and exotic treatment options , without bothering to explain to them that these are unproven.

They will justify the treatment by referring  to anecdotal success stories, without telling patients that there is no evidence to show that these additional treatments help. Anecdotal success stories mean little - after all, a swallow does not make a summer. However, patients who have failed IVF treatment are very vulnerable , and are not sophisticated enough to push back or do their homework, which is why they often say yes. They are happy to clutch at straws and try something "new and better".
Many patients are quite naive, and believe that the more expensive the test or treatment which is offered, the better it must be !

However, more is not always better, and sometimes just repeating the cycle without adding unnecessary expensive bells and whistles is the best option.


Not sure if your IVF doctor is providing you with good advice ? 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 some IVF doctors so unkind?

During an IVF cycle, we provide luteal phase support with estrogen and progesterone after the embryo transfer, to assist implantation. Traditionally, in the past, the progesterone was given in the form of deep intramuscular oily injections.  These oily injections are horribly painful, and most patients say that the one thing they hate the most about an IVF cycle is the fact that they need to take these daily injections . They make the butt very sore, and create hard lumps.

I still can't understand why doctors are so unkind and continue giving these intramuscular injections when progesterone is much more easily administered in the form of vaginal pessaries. Not only is the intramuscular progesterone much more painful, it also doesn't act as well as the vaginal progesterone , because it doesn't get absorbed well into the bloodstream. It forms a hard painful lump, so that very little of the progesterone enters the circulation. Even worse, this progesterone then gets metabolized by the liver, so that the amount which actually reaches the endometrium ( the uterine lining, which is where it finally acts) is reduced.

On the other hand, when we give the progesterone vaginally, it bypasses the liver, and reaches the endometrium directly, so that the levels reached at the final target are much better. It's true that the vaginal pessaries are messy, but this is a small price to pay, and most patients are happy to put up with this discomfort.  IVF patients who have used progesterone pessaries will never agree to use intramuscular progesterone again !


Looking for a kinder IVF doctor ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Overselling PGD

IVF treatment has a limited success rate, and this is partly because of the fact that human reproduction has its own biological limitations. The pregnancy rate, even for a fertile couple who has sex every single day in the bedroom, is never going to cross 25%, no matter how young they are, and how many babies they have had together. However, infertile couples sometimes lose sight of this biological fact, and have very unrealistic expectations from IVF.  These false hopes are sometimes stoked by IVF doctors, who promise them the earth and moon in order to get them to sign up for the IVF treatment.

This is why, when their good looking embryos fail to implant, they are desperate for answers. They want to try something more " advanced", in the hope that this will improve their chances of success. IVF doctors are quite happy to provide " solutions" , For example, many recommend that they do PGS for aneuploidy screening , in order to check whether the embryo is genetically normal or not.

Unfortunately, this is a technique which (as is usual with a lot of new IVF techniques) is being oversold. Very few doctors talk about the potential harm which can be caused by doing unnecessary biopsies - it;s very easy to kill an embryo while doing an embryo biopsy.

While papers published in medical journals by researchers quote high success rates, this can be very misleading . Most IVF clinics can never match those rates because they simply don't have either the experience or expertise which these researchers do.

IVF patients have burned their fingers with PGS FISH in the past, which instead of improving success rates actually ended up reducing them. I think the same thing will play out for CCS/ NGS  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 !

The expensive lessons some IVF patients learn

I was talking to a patient who had failed an IVF cycle and she was extremely unhappy about the quality of care she'd  received. There was very little transparency, she didn't have any medical documentation. Her doctor refused to give her photos of her embryos.

I explained to her that this was not acceptable ; that all good IVF clinics provide embryo photos routinely before the transfer, even if the patient does not ask for them.

I told her that good patients learn to check out these basics, and insist on proper documentation before starting the IVF cycle. Her response was, "I am just a patient, what do I understand about all these technical niceties. I trusted my doctor , and did everything he told me to do."

Sadly , not all IVF doctors are created equal, and the most important task of an IVF patient is to find a good IVF clinic. She had learned the hard way that not all IVF doctors are good, and just because they have a brand name, this does not mean that she can afford to leave everything upto the doctor.

She had been taught an expensive lesson , and this was a heavy price to pay. It was not just the money - it was the emotional trauma she was suffering, because she now felt cheated.  The confidence she had in all doctors has now taken a beating.

The good news is that it's possible to learn these lessons for free today , thanks to the internet . Patients can empower themselves with information therapy , so they know what questions to ask an IVF doctor before signing up . Good doctors encourage questions, and because they respect their patients , they will take the time and trouble to educate them. The tragedy is that if you fall in the clutches of a bad doctor, then even God can't save 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 !

Treatment creep in infertility

 In the past, infertility treatment used to be fairly straightforward, because doctors didn't have much to offer to patients. They could perhaps educate them about when to have sex ( by tracking their
" fertile time "; or tell them to have sex more frequently, but most doctors were forced to advice infertile couples to take a "wait and watch" attitude. With the introduction of clomiphene a few decades ago, we actually had a medical treatment we could offer to patients to help them to grow eggs, and this was a huge advance.

Over time, assisted reproductive technology ( ART) has improved considerably, which means there are now lots of treatment options we can offer to infertile patients, and this is why IVF is one of modern medicine's success stories.

The downside of this has been indication creep. This means IVF doctors have become increasingly aggressive about offering treatment options to their patients. Even young patients who could get pregnant with simpler treatment options are now being offered more complicated aggressive options, which are more expensive.

There are multiple reasons for this. It's not that doctors are greedy and they want to make more money. Patients also are under considerable time pressure, and they want quick results. They don't want to wait and go through all the simpler treatment steps systematically before getting a baby. They're quite happy to go to IVF directly if this gives them the baby which they want, without their having to waste time.

Another reason for this time pressure is societal. Women are getting married at an older age, which means their biological clock is running out and time is at a premium for them.

While the more advanced treatments have better success rates, they are also more expensive.  While aggressive overtreatment can be helpful for patients who are mature enough to make their own decisions, it can also be misused, and lots of doctors will over treat patients only in order to maximize their income.

Doctors and patients need to find the right balance. Just because a doctor can do IVF doesn't mean that he should be doing it for all the patients who come to him. Patients should be encouraged to make these decisions for themselves after their options have been explained to them.


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 do patients select bad IVF clinics?

Patients spend a lot of time, money and energy in selecting an IVF clinic for their treatment, because they know that a lot depends on this decision. While they cannot possibly influence the outcome of the IVF treatment cycle , choosing the right clinic maximizes their chances of having a baby, because a good clinic has high success rates , and follows the right processes.

However, many patients still continue going to poor quality IVF clinics, even though there are many good IVF clinics today. Why do they select so poorly ? I think the reason for this is because they don't bother to do their homework . They do not try to find out what the characteristics of a good IVF clinic are ; and they are clueless about the deliverables which a good clinic provides. The perfect deliverable would be a baby, but the harsh truth is that IVF cycles do fail, no matter how good the clinic is. Patients need to invest in learning more about IVF, so that they become sophisticated enough to differentiate between a good clinic and a bad clinic.

Lots of patients say - I am just a patient , so how can I do so ? Shouldn't the fact that I am going to an IVF specialist be enough ? After all , isn't it the doctor's job to provide me with the right medical care? How can I possibly learn to differentiate between a good doctor and a bad doctor  - I am not an expert !

This is extremely naive. Patients cannot afford to be passive, and they cannot expect doctors to regulate themselves . Sadly, the medical profession tolerates bad doctors because they are colleagues and peers. All IVF doctors know there are bad IVF clinics which indulge in malpractices , but no doctor is ever going to speak up in public about these because they don't want to bad mouth each other. Criticising another doctor is seen to  be politically incorrect, which is why most doctors keep quiet, even though they know that the IVF clinic is cheating patients and taking them for a ride. They will complain in private, but do not have the courage to do so in public. This professional conspiracy of silence is one of the reasons why bad IVF clinics continue to flourish. They take advantage of the patients' ignorance - and it can be very easy for a doctor to fool the patient.

While clinics are to blame, I think patients are to blame even more. After all, you can't change some else's behavior ! Because there is a financial incentive for clinics to offer poor quality services, they will continue to do so, because this increases their profit margins.

There really is no excuse for patients not being willing to do their own homework, especially in this day and age , when so much information is so freely available online.

The good news is that the key question the patient needs to ask is very simple - Does the IVF  clinic provide embryo photos routinely for all patients before the transfer? If it does not, this is a red flag, and you should look for a better alternative.

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 !

Earning the trust of the patients who has failed IVF patient

 It can be quite challenging to treat patients who have failed an IVF cycle in another clinic. One would expect that it would be easier to manage these patients , because they're already aware of what's involved in IVF treatment. They understand that they need IVF in order to have a baby; and because they have been through an IVF treatment cycle , we don't need to spend much time in walking them through the nitty gritty of an IVF cycle .


However, a big problem we find is creating trust in these patients. Once they've failed an IVF cycle , they often lose confidence in all IVF doctors. A lot of them feel abandoned by their earlier IVF doctor , many of whom will refuse to even talk to them after the failure.

We therefore need to invest a lot of time in earning their trust . We find the best way of doing this is by educating them , so we can explain to them what make us different. Many patients appreciate the fact that we are open and transparent - and because they have already been through an IVF cycle, they now have a basis for comparison, so it's easier for them to see how and why we are better !

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 !

How to do a bad medical research study

I just read an  Times of India article on the incidence of miscarriages in India, based on a "research study" published in the Journal of Ob/GYN of India.

This is a classic example of a completely pointless study , which was distorted in order to leave a completely wrong impression in the minds of Indian women, and create a lot of unnecessary fear and anxiety.

The study was only a report of information collected by a group of gynecologists across India. It was sponsored by a pharma company, which got gynecologists to ask their patients who had had a miscarriage in the past to fill in a form which asked a few specific questions about their medical history  .


The study did not provide any new information or reveal any new insights. The hidden agenda of the pharmaceutical company was to keep KOLs ( key opinion leaders ) happy, by reimbursing them for their effort in doing this"  research ".  Gynecologists are very happy to participate in such research studies, because they don't have to do anything other than take a history - something which they do routinely all the time . It's great to get paid for doing nothing -  and it's a great ego boost, because the doctor's name now appears as an author of a published research study in a " leading " medical
journal !

Doctors are happy because they were selected by a leading multinational pharma company to perform research - something which every clinician wants to do, because doing research is the ultimate dream of doctors who think of themselves as being scientists. Since they can't do any original research on their own, they're happy to participate in these kind of research studies. Even better, they get paid for their "research" !

The research was a complete sham. It didn't provide any useful information and should never have been accepted for publication. However, it seems that Indian journals have pretty low standards - especially when the pharma company who sponsored the study is also an advertiser who pays for full page ads in the journal - we know that the piper who has the money can select the tunes !

The " researcher" ( who works for a pharma company and is an author of the paper) then  collected and  compiled this data; and jazzed it up to create lots of pointless tables and figures ; and then got an Indian journal editor to publish it.

To add insult to injury, the PR company for this company wanted to make sure it would get more publicity for this study, which it never would if it were printed in an Indian medical journal. They decided to put a spin on the story , distort it even further, and then got a leading newspaper in India to cover it. Sadly, medical journalists in India don't have enough technical expertise to separate the wheat from the chaff. The reporter uncritically accepted the study's results because they were published in a medical journal, and reported the published findings. The headline writer made the problem even worse by adding a completely misleading headline ! It was very catchy, and this served her purpose because it got people to read the story, but it actually left them with a completely wrong impression. These are the kind of poor quality medical research studies which give the medical profession , pharma , and medical reporters a bad name.

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 do I focus so much on bad IVF practices in my blog ?

A patient was complaining to me . She said - Your blog is all about what bad IVF clinics do and how they take patients for a ride. There is so much negativity in your blog, and you seem to keep on bad-mouthing other IVF doctors. This scares patients, and gives all IVF clinics a bad reputation. Don't you think you are creating harm rather than good ?

This is a great point,  and here's my answer.

The Indian healthcare system is still immature, and patients are vulnerable.  Yes , there are lots of good IVF doctors whom I respect, and I don't need to write about them, because they  already  do what's in their patient's best interests. I highlight the malpractices and dodgy shortcuts that the bad IVF clinics use, so that patients can protect themselves.

I believe openness and transparency helps the entire ecosystem. Hopefully, patients will stop naively assuming that all doctors are equally good and will start asking their IVF doctors the tough questions. This will cause the bad IVF doctors to improve, because they will realise that they can't get away with cheating patients. And this information does  help the good IVF doctors, because the trust which their patients have in them  increases when they can see that they are following good medical practices !

The mistakes IVF patients make out of desperation

A patient sent me an email recently. She'd already failed two IVF cycles because of severe endometriosis and a poor ovarian response, and she wanted my advice. I suggested to her that her best option would be to repeat the IVF cycle, or perhaps considering using donor eggs.

She wrote back saying, "I'm not prepared for another IVF cycle, but I can't sit still doing nothing. I need to take some sort of treatment, which is why I'm doing acupuncture and doing fertility yoga, as well as taking a lot of supplements."

I can understand her desperation, I can understand her unwillingness to repeat the IVF cycle, but I don't see how doing alternative medicine is really going to help her. It's unlikely to give her what she wants, which is a baby, and I think doing things by half measures doesn't really help anyone else, because it creates a lot of false hope and really gets her nowhere. Perhaps she'd be better off considering either adoption or child free living, rather than living in limbo.

She also wanted to know if she could do any further tests to find out if her endometriosis had recurred or not, so she wanted to know if she should do a pelvic 3D ultrasound as suggested by her acupuncturist. She could of course do this, and the ultrasound would find the cyst, but I still don't see how this would change her treatment options in any way. There would be no reason for her to worry if the cyst came back, and even if the cyst has disappeared this wouldn't necessarily increase her fertility.

I also get upset when acupuncturists suggest investigations which are based on Western medicine, such as ultrasound, because I think this is being false not only to their own profession, but is also a misuse of a diagnostic technique , because these diagnostic procedures are best ordered by Western medicine specialists who understand their pros and cons and can use them intelligently. Practicing this kind of bastardized medicine , where doctors try to use the best of both worlds , often means they end up giving their patients the worst of both.


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 New Year Resolution for infertile couples

For lots of young women , infertility is always an important problem but never an urgent one .  This is why they always keep on putting off having a baby .

They feel - I'm only 31 ; I am fit; I exercise regularly; and I have regular periods, so maybe I'll think about it when I'm 32 . When they become 32, they say, let me finish this challenging assignment which will ensure I get a promotion, and I can plan my baby next year. When they are 33, they say - I am get getting my dream job in another company, so I should make the most of it now. I'll have a baby when I'm 34. And if I have a problem getting pregnant in my bedroom, I can always do IVF .
The trouble is that time slips away very easily , and before they realize it they're already 35 and their ovarian reserve has declined . This means they have a hard time having a baby, even if they want to do IVF, because they do need to have good quality eggs to get pregnant !

This is why the new year can be such a valuable wake-up call. It's a bit like an alarm on their biological clock  which wakes them up. A lot of women say, "My New Year resolution is to have a baby before this year is out." This helps them to put the problem in focus , so they can devote their time and energies to getting pregnant . It also allows them to make sure that they can get their husband on the same page , so that they can have a baby before they get too old.
   
If you are thinking about having a baby, and want to defer the decision, you should check how much time you have left on your biological clock by testing your ovarian reserve.

Check your AMH level, which is a simple blood test; and your antral follicle count by doing a vaginal ultrasound scan . This will allow you to make a well-informed sensible decision !

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 Indian heart patients cannot benefit from the latest medical advances

Newer digital stethoscopes enable doctors to not only listen to heart sounds and record them, but handheld devices provide high-resolution ultrasound that can actually “see” what’s wrong with the heart. “Why do you want to still focus on these heart sounds that provide very indirect information and secondary acoustic events?” asks Eric Topol, MD, chief academic officer of Scripps Health in San Diego and a practicing cardiologist.

Sadly, Indian patients and doctors will never be able to benefit from these advances, because the PCPNDT Act bans the use of portable ultrasound devices !

Why are the success rates of the new IVF clinics in India so low ?

One of the big problems with government medical colleges and hospitals in India today is that they have failed to keep up with the times. Thus, there is practically no public hospital in India which offers IVF treatment. However, these hospitals are the ones which provide training to future gynecologists. This means that the gynecologists who graduate from these colleges are half-baked because they have no practical exposure to IVF treatments.

The senior professors are dinosaurs who have never done an IVF cycle in their life; and refuse to learn. They feel threatened because they are ignorant about IVF technology, and they will not allow their younger colleagues to learn these either. As a result of this dog in the manger attitude, the young gynecologists who graduate from these premier medical institutes become second class gynecologists when they enter practice, because they have no exposure to IVF. They find it hard to attract infertile patients because their training is incomplete - they have crammed lots of theory, but have no practical skills in doing IVF.

When they find that they cannot offer state of the art IVF treatment to their patients, they feel
handicapped , and try to compensate for this deficiency by acquiring additional training. Some will go abroad; others will do a fellowship with a leading private clinic; and some will join as junior faculty members in large private corporate hospitals , in the hope that they can learn by osmosis.

However, they get very limited hands on training in these settings, because  doctors in private practice will not allow inexperienced juniors to acquire skills by using their patients as guinea pigs. This is why most of these young gynecologists are forced to sign up for a short training course, with the hope that they will be able to attract patients based on this certification, and will then learn the skills by winging it in real life.  Some of these courses are better than others ( for example, those which are certified by the FOGSI ) , and hopefully they meet a certain basic standard. However, I always worry about how a junior doctor can become an IVF specialist just by spending 7 - 28 days learning these techniques, many of which can be extremely challenging and complicated.

Of course, once the doctor has this " certification" , he can then call himself an IVF specialist, and start treating his poor, unsuspecting patients, who have no way of determining how good ( or bad) his technical skills are. This is why so many IVF patients end up in trouble, because their doctors often do not have the required expertise or the experience to deal with difficult problems.

This is one of the reasons why the success rates in a lot of new IVF clinics ( many of which are run by doctors who don't have enough exposure to IVF) have such dismal success rates.  Some of them will have the grace to refer the patient to a genuine specialist, but unfortunately these are few and far between, as a result of which we now have a lot of cobbled, makeshift solutions.

For example, some will "import" the entire IVF team and do IVF cases in batches.  These are all sub-optimal solutions, and it's high time medical colleges started providing training in IVF and endoscopy for all gynecologists whom they train. Ideally, the Medical Council of India should refuse to recognise any OB/GYN Dept which does not offer IVF  treatment - this is the only way of ensuring that they get their act together and can no longer get away with providing their residents and patients a raw deal by refusing to keep up with the times.

This is why it's important for patients to ask their IVF doctor where he got his IVF training ! If he refuses to give a straight answer, this is a red flag and you should worry a lot !


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 !

PGS and the older woman

PGS ( preimplantation genetic screening, using CCS or NGS) is one of those techniques that seems to make a lot of logical sense. We know that older patients have a lower chance of getting pregnant with IVF. Because their eggs are older, they have more genetic problems as a result of aging. This is why more of their  embryos are genetically abnormal, even though they may look fine under the microscope. When we transfer these genetically abnormal embryos into the uterus, they fail to implant; or even if they do implant , this usually ends up in a miscarriage. This is why older women have a lower IVF success rate, as well as a higher miscarriage rate. Therefore, logically, it makes sense that if we use PGS for aneuploidy screening for these patients, we'll be able to discard the genetically abnormal embryos and if we then selectively transfer only the genetically normal embryos, they have a higher chance of getting pregnant.

Because PGS makes logical sense, this has become the fashionable treatment option for lots of older women - especially older women who have failed IVF cycles. The doctor tells them that they need to do PGS to select a genetically normal embryo , and thus reduce the risk of failed implantation.

However, this often doesn't work out well in real life . Older patients often have poor ovarian reserve, and therefore, poor ovarian response. As a result, they end up getting few eggs, and very few of their embryos end up making it to the blastocyst stage, as a result of which our ability to do PGS and get reliable genetic information from these blastocysts is very limited. This means that even if we intend to do PGS for 100 older women, the actual number for whom PGS can actually be utilized becomes  very small. However, women don't understand this, as a result of which they're quite happy to sign up for the program.

Doctors are happy to offer PGS because they can charge much more for a PGS cycle. Even if they don't get around to being able to transfer a genetically normal embryo, then at least they can tell the patient "We did our best, and we tried to go ahead and do a biopsy, but because your embryos arrested / or because they formed  blastocysts of poor quality , we could not do the biopsy, sorry. " In other cases, we can manage to do the biopsy, but we fail to get any useful diagnostic information from the blastomere because of technical limitations.

While it's true that PGS can be helpful for a small proportion of older women ( those who grow lots of eggs and form enough good quality blastocysts) , the reality is that PGS has its own limitations . It's not something which can be blindly applied across the board , and patients need to understand this before signing up.


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 do bad IVF clinics continue to flourish?

Now that IVF technology has become mature, one would expect that most IVF clinics would follow standard operating procedures  and provide high-quality services to their patients. After all, doctors are meant to be ethical professionals who follow recommended medical practice guidelines. Patients expect to be able to trust their doctors, which is why a lot of them naively believe that all IVF clinics are created equal . Many will happily go to whichever clinic happens to be nearest to them , or the one which offers the best price. This is one of the reasons why bad IVF clinics continue to flourish.

Sadly, there' still isn't enough regulation or governmental oversight, and the medical profession refuses to police itself, which means that patients are pretty much at the mercy of the doctors' conscience. If they happen to end up in the hands of a bad IVF doctor, then no one can save them.

It's very easy for bad IVF clinics to take advantage of patients' ignorance. For one thing, patients in India aren't used to asking their doctors questions. Doctors are treated as Gods, which is why it's very easy for them to bully their patients. Bad IVF clinics use a lot of misleading techniques to trap patients. For example, they will advertise in newspapers , and quote extremely low rates in order to get patients to sign up for the treatment. Once the patient has done so, they keep  on progressively increasing their charges, and once the IVF cycle has started , she can't possibly back out, which means she is stuck. Others will organise  mass free medical camps for infertile couples, and use this as a source of patient acquisition, under the garb of providing a community service.

It's easy for them to get patients pregnant, by doing IVF for young infertile women who never needed IVF in the first place, and could have got pregnant with simpler treatment options. This allows them to tom-tom their successes. For the other patients, they will often use donor eggs and donor embryos, without the patient's consent, to boost their pregnancy rates.

Lots of these underhand practices are extremely prevalent in Indian IVF clinics, and the worst thing is that even the good doctors are a party in allowing these to flourish. While they don't indulge in these underhand tactics themselves, they keep quiet about them, and thus allow the bad doctors to get away with their dirty schemes.

Because IVF doctors indulge in a conspiracy of silence, out of misguided professional courtesy , all IVF clinics end up being tarred with the same brush because of the antics of a few bad doctors. Patients who have been cheated by one bad IVF doctor lose confidence in all IVF doctors  because they've had a bad experience. Good IVF doctors can't afford to keep quiet about this - we need to speak up in order  to protect our patients !

The problem is that it's very easy to fool some of the people some of the time, especially in a field like IVF, where there are no guarantees. When the cycle fails, the patient doesn't know what the reason for the failure was. Was it because the clinic was incompetent, or was it just plain bad luck ?

It's easy for  bad IVF doctors to bamboozle their patients, by blaming the IVF failure of poor quality eggs or bad sperm ! They preying on their patient's ignorance and take them for a ride. Sadly, patients are often not sophisticated enough to be able to determine the technical quality of the treatment they receive. Many blindly assume that all doctors are technically competent, and patients don’t expect to get robbed at the doctor’s office !

However, thanks to the internet, patients are becoming smarter, because they can start sharing their personal experience at various IVF clinics. It's interesting that IVF patients trust other patients more than they trust IVF doctors ! This kind of information sharing and openness will help them to separate the good clinics from the bad clinics.

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 !

Finally pregnant ! A guide for infertile couples

Why do doctors treat patients as idiots ?

A patient sent me this email.

 My doctor did an ultrasound scan for me and because my uterus is retroverted and retroflexed , he has advised me to do a hysteroscopic metroplasty.

I get angry when I see how some doctors take patients for a ride, simple because their patients trust them. A retroverted and retroflexed uterus is completely normal, and does not affect a woman's fertility. In fact, doing unnecessary surgery is likely to cause much more harm and reduce her fertility, because of the scarring which it can cause.

Patients cannot afford to blindly trust all doctors. They need to verify that the information which their doctor gives them is reliable !

Become an expert fertility patient !

We feel all infertile couples  should become experts on their medical issues, so they can get the best medical care. 

Finding the right IVF doctor is the key to success, but since all doctors are not equally good, you need to do your homework, so you can differentiate between a good doctor and a bad doctor.

Here are more articles to help you learn more about infertility !

http://drmalpani.com/knowledge-center/articles/bbt-charting-is-it-really-useful-to-infertile-couples

http://drmalpani.com/knowledge-center/articles/bromocriptine-its-use-in-infertility-treatment

http://drmalpani.com/knowledge-center/articles/crypto

http://drmalpani.com/knowledge-center/articles/about-social-egg-freezing

How IVF doctors take patients for a ride

A patient just sent me this email.

Have done IVF and it is my third month. Irrespective of the health condition , the doctors here are mandating all the patients to stay here for a minimum duration of 5 months . Is it necessary ? Also as a common practice they do stitching for all the patience who had sucessful IVF after 3 months. Is stitching mandatory ? Also , do we need to have any special injection after stitching ? This is also common to all patients hence they are mandating us to stay for a minimum duration of 5 months.

This patient should be on top of the world now that she is pregnant after IVF . However, her IVF doctor has made her pregnancy a nightmare by medicalising her pregnancy, and forcing her to stay on and take special ( read "expensive") injections; and doing a cervical stitch. This is just a way of scaring the poor patient and extorting more money.

An IVF pregnancy  is exactly like a normal pregnancy and does not need any special care. Unnecessary cervical stitches can actually cause a miscarriage ! After the embryo transfer, patients should go back home and lead a normal life.

Any doctor who tells you that you need "special" care after the embryos transfer is not a good doctor. Patients should not allow doctors to take them for a ride !

Not sure if your doctor is giving you the right advice ? 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 new mantra for IVF success - a New Year post !

IVF technology has progressed slowly, but surely. Most of these advances don't grab headlines, because they are not revolutionary, which is why many patients are not aware of their impact. They are incremental and evolutionary , and the good news is that as a result of these advances, we're now able to provide much higher IVF success rates than we could in the past. This gives us a lot more confidence in our ability to help patients to complete their families.

One of the new mantras for IVF success is a freeze all policy. Thanks to vitrification , our ability to freeze and thaw embryos has become extremely good and survival rates are practically 100% , which means that if freeze a good quality embryo in our lab , the chances of it growing well after thawing are nearly 100%.

In the past , we would transfer fresh embryos into the uterus, during the IVF cycle itself. However, we've now realized that the hormonal superovulation we need to subject the patient to ( to help her to grow lots of eggs) will often subtly distort the  uterine lining, thus reducing the chances of implantation.

Today, the new mantra is that we freeze all the embryos. Initially, this was something we used to do routinely for patients who grew lots of eggs , because we were worried about the risk of hyperstimulation. We observed that the pregnancy rates for these women was extremely high when we transferred their frozen embryos in subsequent cycles.  This meant that something which we started doing because we needed to prevent complications has now evolved into something which we do electively for all patients, even if they just have 3 or 4 embryos. This is because the chance of that embryo becoming a baby is far better when we transfer the frozen embryo to an endometrium  which has been optimally prepared for implantation, because it is much more receptive. This could either be in a natural cycle ; or in a cycle where the endometrium has been prepared with estrogen.

In a fresh cycle, our focus is on growing lots of eggs, and the uterine lining is a secondary concern, which is why it may get compromised. However, when we have frozen embryos to transfer, we can focus our energies on ensuring that the uterine lining is perfect. This single-minded focus helps to improve success rates. This option does cost a little more ( because we need to freeze and then thaw the embryos); and takes the patient a little more time ( because she needs to come back again for the transfer), the cumulative pregnancy rate with this technique is far better.

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 !

New articles on Infertility for the New Year from www.drmalpani.com !

http://drmalpani.com/knowledge-center/articles/ftr-fallopian-tubal-recanalisation-2

http://drmalpani.com/knowledge-center/articles/is-an-embryoscope-really-useful

http://drmalpani.com/knowledge-center/articles/is-it-necessary-to-remove-a-hydrosalpinx-before-doing-ivf

http://drmalpani.com/knowledge-center/articles/how-ivf-specialists-overtest-overtreat-patients