Why some patients doing a donor egg IVF cycle end up with poor quality embryos

This is a post by Dr. Saiprasad Gundeti, Chief Embrologist, Malpani Infertility Clinic Pvt. Ltd.

Most patients who use donor eggs expect to get good quality embryos. After all, if the egg donor is young and fertile, and since embryo quality depends upon egg quality, then shouldn't embryo quality also be great in all donor egg IVF cycles  ?

Yes, this is a perfectly reasonable expectation, and this is exactly the advice we give our patients. For the vast majority, the embryo quality in a donor egg IVF cycle is excellent. However, real life can be messy, and there are always exceptions to the rule. When the embryo quality in a donor egg IVF cycle is poor, this can be an unexpected rude blow, and patients feel upset and angry.
Recently we had a patient who had a very low AMH Level of 0.01. As such a low AMH level indicates that ovarian reserve is very poor, they were advised to do Donor Egg IVF. Since her husband’s Sperm sample was pretty good, with normal Sperm Count and Motility , we advised her that this would be their best option to conceive.

We froze her Husband’s Sperm Sample and a Fertile Egg donor with good AMH level was selected for them. The Egg donor was superovulated, and she responded well . She produced 15 Eggs, for which we did ICSI.

The Egg fertilization rate was very good , as expected, and 12 of the 15 Eggs fertilized. The Embryos grew well till day 3, as 8 out of 12 had become 8-cell Embryos, which were grade A. However, much to our dismay, most of them stopped growing after that and eventually only 2 of them had become Blastocysts on day 5. We transferred them but the patient didn’t get pregnant.

We weren't sure why this happened, and we couldn't really give her a very good explanation. They felt that it would make sense to try again with a different egg donor, and we did so, to see if this would make a difference to the blastocyst quality.

This second donor also responded well and this time we got 16 Eggs, for which we did ICSI.  12 out of these 16 Eggs had fertilized. The Embryos looked great until Day 3 , at which point most of them suddenly stopped growing , and eventually only 2 of them became blastocysts on day 5. This seemed to be a replay of the first cycle,  and we had a sense of deja vu ! We transferred the 2 blastocysts, but to everyone's  disappointment, the patient didn’t get Pregnant.

We analysed both the failed donor egg IVF cycles, and the fact that of  24 embryos , only 4 had become blastocysts , suggested that there was an additional problem we needed to consider. Under normal circumstances , in our lab, of 24 Day -3 high quality Embryos , we would expect to get at least 8 good quality blastocysts.

We concluded that the most likely reason for this unusual problem was because of a potential sperm problem, where because of the late Paternal Effect , the sperm DNA was not able to support embryo growth after Day 3.

Fortunately, they were a mature educated well-informed couple,who were able to understand the technical niceties of our explanation.  The fact that we were transparent and openly shared information with them increased their confidence that they were getting the best medical care, and they are now thinking about whether they should get a sperm DNA fragmentation test; and then consider embryo adoption.

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 !

I have invested in Babygogo

New Delhi-based child healthcare startup Babygogo has raised $300K (INR 2 Cr.) in seed funding from a clutch of angel investors including Rajul Garg, a veteran in healthcare investment, having invested in Qikwell, HealthKart & Cygnus Medicare earlier.

The other investors included Dr Aniruddha Malpani, IVF specialist from Mumbai and an angel investor; Daljit Singh, President of Fortis Healthcare; Aditya Vij, ex-CEO of Fortis Healthcare; Salil Kapoor, ex-COO, DishTV; Dr Kishore Kumar, Founder & Chairman, Cloud Nine Hospitals; Ashu Agarwal, Director, BW Accelerate; Ashish Tulsian, Founder, Posist; Afsal Salu, Founder Delyver; Dr Shuchin Bajaj, founder of Cygnus Hospitals; Dr Ritesh Malik, founder of Innov8.

Babygogo is a community of parents and doctors where parents seek information and help about child health care. The platform enables new parents to browse information and articles on things like baby food, health and day-to-day parenting.

Read more at http://inc42.com/buzz/babygogo-seed-funding/

This is a great example of how clever entrepreneurs are helping doctors to improve  the care they provide to their patients !

How to get the best medical care - free book online !

You can read the book free at 
http://thebestmedicalcare.com/how-to-get-the-best-medical-care.html

IVF success story - blessed with a baby after treatment at Malpani Infertility Clinic

Life is simple for people like us until any external factor makes it complicated. But what if the complication begins internally. Not a philosopher but life definitely comes up with a philosophy and that is let you make your life smooth let you live it simple but I am the creator I have some different plans for you. And thus God has his own plans for us as well.

 I and Mamta got married in 2009 and like others started our journey of knowing each other with all sorts of experience. Our journey was on the best of our joyride until one day we found ourselves on its roller coaster. The day I found myself numb for a while with no action of thoughts but still I had to be strong enough to make myself mentally active. My wife didn't even had time to realize what actually was on inside her body and all of sudden she went through the most horrible experience of her life where she found herself battling for breath. We rushed to the hospital, things turned puzzle within hours. I was told that something had burst in her right ovary and her body was filled with its residue All the new, unknown, complicated medical terms in front of me where only thing I knew was I want her back fit and perfect. After a long hours of operation things were in our favor and I got her back but with lot of painful days of her being weak and not able to live a normal life for at least an year.

After being declared as physically fit we thought of expanding our family as every couple does. But unlike other females my wife was no more a strong and normal women. Now she just had an ovary which clearly reduced fifty percent of chance of having a normal baby. And then one day when she went for a normal scan we were told like the same which happened in right ovary was on in the left as well. It made us scared and we really never wanted to take another chance of doing any kind of experiment. My sister in law just went to her successful attempt of IVF with Dr Anirudh and Anjali Malpani and was expecting her baby. We also were not at all in mood of delaying things and immediately handed over our case to Dr Malpani.

With just one discussion on mail we were sure things will just be right here. With no operation my wife's left ovary was cleared up by doing a simple ultrasound guided cyst aspiration and she was fine within a day. But because of just one ovary we were advised to go for IVF. So things were carried forward and we did our first IVF on February 2014. We did what we could do but things are not always in our favor, it was our hard luck or better would be to say that it was not the right time and we didn't got what we expected. We took a break for a year.

And again tried our new IVF cycle with a new pool of hope on March 2015. With Dr Anjali's excellent skill of taking out eggs from just one ovary it was amazing to know the numbers. This cycle was positive in every was and with God's blessings this time we had a good bunch of embryos as well. With an excellent approach of counseling his patients and making them mentally strong Dr Anirudh Malpani always made us mentally positive and strong to live this tough phase of life. More than me it was my wife who was actually going through life's most complicated journey which was hurting her mentally and physically both but positive approach of Dr Malpani just kept her going to each step of this journey.

Her second IVF was done and her result pregnancy test brought shower of happiness in our lives. This time it was positive and that was all we wanted and wished for. But things didn't stop here life has a lot more. Suddenly one day she started bleeding and some careless medical practitioner declared that nothing was left inside. It was natural that we all were hurt. My wife took her decision on her own, had a word with Sir Malpani and his behavior of handling each of his patient personally is commendable. He immediately advised to do a retest of the sample in another lab and asked my wife to take rest. After a week or so it clearly indicated that my wife was pregnant and our lives filled with joy once again.

With on and off a tough journey of pregnancy and blessings of God and our elders and with a strong and superb positive and experienced to the point support of Dr Anirudh & Dr Anjali Malpani and hospital staff and their team members today our lives are filled with giggles of our little baby Advik who arrived in our world on 16th November 2015 and gave a new aim to our life. Being thankful will be very less its like they gave us a new life. We both truly appreciate all your efforts to fulfill lives of couple like us so happening and showering our lives with happiness. We wish you all a very best in life.


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Being able to help create success stories like this is one of the reasons why being an IVF specialist is the best job in the world !

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 !

Does yoga improve IVF pregnancy rates

This is an important question but it's a difficult one to answer.

Some doctors will swear that it helps to improve fertility, and so will lots of patients. However, this is what we call anecdotal evidence - I did yoga and I got pregnant , which means that yoga improves pregnancy rate.  The problem is that we are then confusing correlation with causation, and it's very hard to document a cause and effect relationship when there are so many confounding variables.

There will be other doctors who'll say, "No, this is not evidence based medicine. No one has ever proven this , because no randomised controlled clinical trial has been done," . In their mind, this proves that yoga doesn't improve pregnancy rates.

The truth is that we still don't know whether the answer is yes, or whether it is no. Perhaps, the answer is - Maybe , and that in some patients, it's possible that yoga improves clinical pregnancy rates but we don't have proof as yet.

The reality is that no one's going to do a clinical trial to answer this question, because it can be so expensive to do so .

This is where empirical therapy comes in. Yoga is a low cost, low risk intervention, and it's well worth trying . There are no downsides to doing it, and while we don't have any proof that it improves fertility, the fact that it may help means there's little downside in doing it to see if it helps 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 !

How your embryologist sets up your culture dishes for ICSI in the IVF lab

Non-invasive testicular sperm extraction without making a cut

The key role of keeping embryos at the right temperature in the IVF lab

Infertility tests which raise more questions than they answer

Both doctors and patients are fascinated by new and fancy diagnostic tests . When things don't go as predicted during the IVF cycle, the natural response is to run more tests , so that we can get more information , which will allow us to pinpoint the problem and make a more accurate diagnoses.

For example, when your patient has poor quality embryos and you suspect this is because of a sperm problem, the first question the patient is going to ask is, " How do prove that this is because of a sperm defect?"

One of the tests available to test for sperm function is the sperm DNA fragmentation test, and it's very tempting to order this. After all, the sperm is just a DNA carrier -
a packaged missile which delivers the man's DNA into the egg to create a new embryo. If there is a lot of sperm DNA fragmentation , then isn't it obvious that you will get poor quality embryos with lots of fragmentation ? After all, if  the sperm quality is impaired , and if the sperm provides 50% of the DNA to the embryo, and if this DNA is fragmented, then it's logical to conclude that this is a cause and effect relationship - that poor quality embryos in a man with defective sperm are because of the poor quality of the sperm.

I wish life were that simple , but biology is far more complicated, and does not always follow what seems to be logic and common sense.  While it is true that men with high sperm DNA fragmentation are more likely to have fertility issues, it's also equally true that for the individual patient there is no cut-off value for sperm DNA fragmentation which demarcates fertile men from infertile men.  This means that there are
lots of fertile men who have high DNA sperm fragmentation levels; and that there will be men whose sperm DNA fragmentation is completely normal , who will still end up with creating abnormal fragmented embryos in the lab, even when they do ICSI with high quality donor eggs.

This is why we need to be selective when ordering these tests. Ordering them is easy, but interpreting the test for the individual patient is very difficult ! How do you make intelligent use of the information once you get the test result - that's what makes medicine so challenging and complex !

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 did my IVF cycle fail? What went wrong, Doctor?

I just had a chat with a patient where we had transferred perfect blastocysts into her uterus with a perfect endometrium. She hadn't got pregnant so she was obviously concerned and wanted to know - What went wrong doctor ? Did I do something wrong which stopped my embryos from implanting ?

I told her that just because the IVF cycle had failed did not mean that anything had gone wrong - and that the word wrong itself was the wrong word to us. It's an emotionally charged term, which is very judgmental. It suggests that the reason for the failure was that either something was wrong with the medical treatment ; or that there's something wrong with her uterus or  her embryos.

The reality is that implantation is often a matter of luck. I agree luck is not a very scientific word , but not everything in biology can be dissected, explained or controlled, and the sooner we learn to accept this, the better for everyone ! However, this requires a lot of maturity, and counseling is extremely important . Patients need to to accept that the IVF success rate is not 100%, that while we can control some variable to improve their chances of success, once we have transferred the embryos back into the uterus , we have no control over the implantation process. This is why patients need to do their homework, so that they have realistic expectations before they start the cycle.

We always do an analysis for every IVF cycle , but we don't wait to do it until after the beta HCG is negative. We do a premortem, at the point of the transfer , because this is the final checkpoint , over which we still have some control. After this, we have no ability to predict or manipulate the fate of the embryo , which means there is no point in doing any further analysis , because we still cannot open this black box. After transfer, everything is guesswork, and speculation about the final outcome is quite pointless.

At the time of transfer , we check the endometrial thickness and texture; we check the quality of the embryos , and show them to the patient; and we make sure that the embryo transfer went smoothly. If all these three things are fine, then we tell the patient that their IVF cycle went off well. However, this doesn't mean that they will get pregnant in this cycle, no matter how much we would all love for this to happen !  The good news is that if the cycle has progressed well, this means that we have been able to find the right medical formula for you. After this, it's just a question of being patient and repeating the cycle, until you finally get lucky !

This requires a lot of maturity and discipline on the part of the patient. However, it's important that patients don't start getting desperate or frustrated , and they should not ask the doctor to change the treatment protocol just because the first cycle has failed. Playing the woulda, coulda, shoulda game just adds unnecessary stress to your life, and doesn't improve your chances of getting pregnant !

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 Dr. Vidya Devi Shenoy Oration at the “YUKTI 2016” Annual CME in Hyderabad on How to Delight your Patients

I was honoured to deliver the Dr. Vidya Devi Shenoy Oration at the “YUKTI 2016” Annual CME of the Hyderabad Ob/GYN Society on 20th March 2016.

Dr Vidya Devi Shenoy is a living legend. She is now 94 years old, and still full of life and energy,. She has successfully transmitted this to her daughter, Dr Mamta Deendayal; who in turn has passed on these great genes to her daughter, Dr Arti Deendayal !

In her honour, I tried to describe the qualities which a modern doctor needs to imbibe in order to follow in her footsteps.

How to become a successful doctor from Dr Malpani

How we use the Micromanipulator in the IVF lab to do ICSI

How Dr Google can increase IVF success rates !

There's no question that Doctor Google can be very powerful  - after all, it can provide you with all the information you want on IVF !  

It's also equally true that just like any powerful medicine, it can have a lot of side effects. A lot of husbands are very worried when their wives go hunting for information about IVF on the internet . They often get obsessed looking for abstruse minutiae, and will spend hours searching for information.

Husbands are protective, and are very worried about the effects of poor quality information on their wives. They know that a lot of the information on Google is unreliable, because it comes from  poor quality websites ; commercial organizations which are out to peddle their wares; or bulletin boards, which are full of posts uploaded by clueless patients.  Most of this information which has never been quality-controlled or verified. This is why a lot of husbands will stop their wives from going on the net. They get irritated when they surf for hours on end, and the standard advice they provide is - Please don't become half a doctor  - a little learning can be dangerous ! ,  Why can't you just trust our doctor and let him do what's right for us ?

However, ignorance is not bliss , and knowledge is still power ! The reality is that information is never good or bad - It can either be reliable or unreliable; updated or outdated; easy to understand or hard to figure out.  It's not the information per se which causes problems , it's the way you interpret it ! This depends upon your background knowledge, which allows you to make more sense of what you read; and your ability to critically interpret it .  Are you able to analyse the context in which the information is being provided ? Is it an individual person's opinion ? an established medical fact ? is it based on extensive research? or is it the result of a single animal study ?

It does require a sophisticated user to make good use of Doctor Google.  Blaming Doctor Google really doesn't help anyone.  Just like a powerful drug, which can have good effects as well as side effects , it's up to us to learn to use such a powerful weapon intelligently.  It can help you find the best IVF clinic, for example, by making sure you ask the right questions to the IVF doctor when selecting a clinic. It can teach you about the importance of demanding photos of your embryos, and how to interpret them, so that an IVF clinic cannot take you for a ride !

The combination of a motivated patient; Dr Google ; and an empathetic IVF doctor who can help you make sense of the information your unearth can definitely help you to improve your chances of getting pregnant !


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 my embryo become a baby ? Why it's so incredibly hard to predict the fate of an embryo

We know that embryos don’t always become babies, but patients would like some sense of what their chances of success are, with the particular embryo we have transferred for them . Thus , we know that blastocysts have a better chance of implanting, as compared to Day 3 embryos; and that top grade blastocysts ( for example, those which are hatching) have a better chance of achieving a pregnancy.

The problem is that the only way we can grade blastocysts today is  by looking at them under the microscope. This is a pretty crude technique, because even if two blastocysts look exactly the same, they may have completely different implantation potentials, and this is one of limitations of embryo grading.

After all, looking at an embryo just provides us with an  snapshot image, and we are much more interested in the timeline of the embryo  because we want to predict its fate. We want to be able to estimate the future of this embryo - whether it will implant and become a baby or not - and this is why a single picture captured at a given instant is not enough.

We need to know much more about the history of the embryo if we want to be able to do a better job. The key question is - what is the quality of the egg which this embryo come from? Thus , let's assume we have two identical embryos, one of which has come from a 25 year old woman, and the other  from a 40 year old woman. Even though the two embryos look identical, the implantation potential of the embryo from the younger woman is far higher. Explaining this can be very frustrating for the older patient, who may be on top of the world that we have been able to create a picture-perfect blastocyst for her.   The truth is that no matter how good our IVF lab is, and not matter how perfect her embryo looks,  her egg quality still plays a very important role in determining the implantation potential of her embryo( Incidentally,  sperm quality has practically no role to play whatsoever, and it is not something we need to worry about when we do  ICSI. )

Similarly, embryos from poor ovarian responders have a much poorer chance of implanting. This can cause a lot of heartburn for these patients.  When you have a patient with poor ovarian reserve, and you can manage to transfer a top a quality embryo for her, everyone is on top of the world. However, the very fact that she has required a high dose of injections in order to grow enough eggs to get a high quality embryo itself means that the implantation potential of this embryo is compromised. The best analogy I can give is of  two cars , both of which are cruising at 20 miles per hour. Now if one car is in first gear, you know that car is performing well; but if the other car needs to be pushed into fourth gear in order to get it to go at 20 miles per hour, you know there is a problem in the engine of the second car , and you are not likely to buy it.

The truth is that there are lots of intangible biological variables involved in embryo development. Since we still cannot track or measure these, we end up doing a poor job of predicting which embryos will implant successfully.  While we can do our best to use superovulation protocols which maximise the number of high quality eggs  we can collect; and while we can try to optimize culture conditions to be kind to the embryos, the truth is that if that gorgeous embryo has a genetic defect , because it’s come from a poor quality eggs, or an old egg, there is nothing we can do to repair that.

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 increase your stress levels when doing IVF

Being infertile is stressful and going through an IVF cycle can be even more so because so much is riding on the outcome of the treatment. An IVF treatment cycle is much more than just a medical procedure, because there are so many hopes, dreams and desires wrapped up in the treatment.

However, the biggest emotion is often that of fear ! What will I do if the IVF cycle fails ? Is there any hope of my ever having my own baby if even IVF fails ?

I feel it's the unrealistic expectations which cause the most stress . Most patients who start an IVF cycle refuse to even consider the possibility that the treatment may not work. They have been brainwashed into " thinking positive" , so they refuse to remember that the chances of the IVF failing for a given patient in any cycle are more than the chances of success !

Most of them keep on repeating the mantra - It's got to work ! It will work ! There are lots of family-members and friends who are hoping and praying for success as well, so everyone is on an emotional high during the treatment cycle, because they need to keep each other's hopes up. The truth is that no one would ever start an IVF cycle if they did not feel in their heart of hearts that it was going to work for them.

This is why patients arm themselves with prayers and lucky charms before and during the IVF treatment. While the IVF process is straightforward - grow eggs; make embryos; and then transfer these into the uterus , the outcome is always uncertain. This is because implantation - whether the transferred embryo will become a baby or not - is a biological process which no one can influence. Along with medical expertise and good protoplasm, it also requires a large dose of luck - the one intangible no one can control !

The truth is that no one can ever be sure of the outcome of the IVF cycle, which is why you need to keep your expectations realistic ! While you cannot control the final outcome, if you have peace of mind you did your best, you will find it much easier to manage your stress levels during your IVF treatment !

Please remember the Serenity Prayer
God grant me the serenity to accept the things I cannot change;
the courage to change the things I can;
and the wisdom to know the difference.

Culturing embryos in the IVF lab - Part 2

Culturing embryos in the IVF lab

A sneak peek at what happens in the IVF lab !

The IVF Incubator - the heart of an IVF lab

What should I do when my patient demands I do more tests?

We often see patients who have failed an IVF  cycle, and the commonest question they ask is, "Why did the cycle fail?" They want a scientific answer, which means they expect us to do diagnostic tests  in order to pin point the problem.

We try to explain the limitations of medical technology to them. When we have transferred perfect embryos into a perfect endometrium, there are very few additional tests we can do which will provide us with any useful information . None of these tests will provide any actionable inputs which will cause us to change the treatment plan. This is why there's not much point in doing the tests, and it makes much more sense to repeat the cycle.

However, this advice, even though it's very sensible, is not acceptable to many patients. In fact, they feel that the very fact that their beautiful embryo did not implant means that there must be something wrong with them, and that it's our job as the IVF specialist to diagnose the problem , so that we can find a solution. They feel that by not doing so, I am being sloppy and careless , and the more uncharitable ones jump to the conclusion that I just want to maximise my income by repeating the same treatment mindlessly. They hope that by running lots of tests, we will be able to find the reason for the failure ,and that by fixing the issue , we will increase their chances of getting pregnant.

Doctor, can't we do some immunological tests to test for failed implantation? Or can't we do the ERA
( endometrial receptivity assay) which I read about on a website ?  If the reason for failed implantation is a genetic problem in the embryo, then shouldn't you be doing genetic tests for us and for the embryo ?

These patients are desperate , and there are lots of tests out there which are being actively marketed to try to determine the cause for failed implantation. The sad reality , which patients often don't understand , is that these tests have major limitations , and often don't provide reliable answers . In fact, they provide completely misleading data, because of the huge number of false positives which they generate.

For most doctors it's just much easier to go ahead and comply with the patient's request , and order the tests. In fact, doing the test is very profitable for the doctor , because he can charge a lot of money for these tests , and the more expensive the test, the more the money he can charge.  Ironically , the costlier the test, the happier the patient , because she feels that the doctor is doing everything possible to try to get to the "root" cause of the failure !

It takes me a lot of time to explain to patients why these tests are useless. When I tell them why they don't require these additional tests, a lot of them are very unhappy. They think I'm old fashioned and not up to date with the latest advances ! Many will leave and go to another IVF doctor. This is why I sometimes wonder - isn't it true that the customer is always right? And if the patient wants the test done , why should I waste my time telling her why she doesn't need it ?  Why not just go ahead and do it, to keep her happy?

How Stress Affects IVF Success Rates

Lots of couples believe that being stressed out will reduce their chance of getting pregnant in an IVF cycle. After all, doesn't everyone know that stress is bad for you, and that it can harm the delicate balance of the reproductive system ?

Many patients blame themselves for their IVF failure by feeling that they prevented their embryos from implanting because of their high stress levels . This is especially true when they start getting early pregnancy symptoms .They start believing that this proves that their embryos implanted, but they couldn't hold onto them, because they were too stressed out , and this caused them to "reject" their embryos. This is one of the reasons why mind / body programs on stress reduction are very popular in IVF clinics - they help patients to cope with their stress better.

However, the truth between stress and IVF success is a little bit more nuanced. I honestly don't think that stress levels affect IVF success rates, because embryo implantation is a biological process and whether you're stressed out or not , if the embryo is going to implant , it will. For example, a woman who gets raped has enormous stress levels , but if she's going to get pregnant , she does. I don't believe that stress causes infertility, I think it's the infertility which causes the stress ! I feel that blaming the stress for the IVF failure is a bit like blaming the victim for being unable to control a biological process , and I think that's unfair.

However, I also believe that patients who can cope with their stress more effectively are much more willing to go through a second and a third IVF cycle. This is what really makes the difference between IVF success and IVF failure for an individual. Patients who are extremely stressed out and cannot cope with the ups and downs of the first IVF cycle will refuse to do a second cycle.  They drop out , and thus deprive themselves of their chance of  having a baby. Because they don't have emotional stamina, they don't  give themselves enough opportunities to allow their IVF cycle to succeed. On the other hand, patients who can cope with their stress well are quite willing to do a second and a third cycle if required. They are mentally prepared and emotionally resilient, which means that over time, their cumulative conception rate is much higher !

IVF, God and miracles

Lots of patients are quite ambivalent about doing IVF. Many with  strong religious beliefs  feel that if they are destined to have a baby, then God will make it happen, no matter what their medical diagnosis is ; and if a baby is not in their destiny, then doing IVF will not change anything at all, so why bother ? It can be very hard to have a scientific conversation with them, because of their preconceived notions.

I can understand their fatalism. After all, IVF doesn't have 100% success rate, and whether an IVF cycle will work or not for an individual patient does to a large extent upon a random element of luck, which you could attribute to nature or to God, depending on your personal beliefs.

However, I remind my patients that God helps those who help themselves, and it's easier for some of these miracles to occur if you give God a chance to help you.

It's true that every baby is a miracle - whether that baby is born because you had sex in your bedroom, or whether you did IVF. However, the more you help yourself, the better your odds are of achieving your own miracle.

I get a little upset when patients take a passive attitude and trust that God will do everything for them - that all they need to do is to pray and have faith. While this always helps, it's never sufficient !

There are lots of uncertainties in the IVF process , and we can never be sure about the outcome. A belief in God or a higher power helps patients cope with the uncertainty and stress inherent in an IVF cycle. It can also perhaps help to increase success rates , especially when you believe that there is a higher power who's looking after you , and who has your best interests at heart.

However, you still do need to take action !

 This reminds me of a story I think you'll enjoy. A young man was having a terrible year. He had lost his job, been forced to take out a second mortgage on his home, and seemed to be spiraling further and further into credit card debt. His terrible financial situation drove him into a deep depression, and it wasn’t long before his social life was in shambles as well. At such a young age, the man felt that his future was hopeless and that he would truly need a miracle to help him climb out of this hole.

With nowhere else to turn, the young man finally decided to do the one thing he hadn’t yet tried – he prayed. He drove his car to his childhood church and found a pew in the back rows of the quiet chapel. He got down on his knees and he prayed.

“Dear God, please help me win the lottery. I really need the money, so please help me win.”

The young man waited several days and nothing happened. He returned to the church.

“Dear God, I’m not sure if you received my last prayer, but I really need your help to win the lottery. Please help me out here.”

Again, the young man waited several days with no results. He returned to the church once again.

“Alright, God, I’ve asked you twice, but it really seems like you aren’t listening to me. I asked you to help me win the lottery, but I still haven’t won. Are you even listening to me?”

What happened next truly shocked the young man. He heard a voice. The clouds parted and God spoke from above - “BUY A LOTTERY TICKET!”


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 !

Please don't abandon your embryos.

Many young IVF patients have extra embryos which we can freeze, and we strongly recommend that they routinely freeze these embryos. This is a decision they need to make when we transfer their fresh embryos for them, but lots of patients aren't sure about whether they should spend the extra money need to freeze their embryos, because they are's sure about the value of doing so.

This is true for multiple reasons. For one, if they have high quality embryos, they are so hopeful that they will get pregnant in the  fresh cycle, that they do not see the need to freeze their embryos.

Others still believe that frozen embryos aren't as good as fresh embryos , and that the success rate with these is poorer , because they do not survive the thaw. This is partly because the technology in the past for freezing embryos wasn't very good, and when we used the older slow freeze and thaw techniques, about 50 percent of embryos would die.

However, this has now dramatically changed , thanks to vitrification (http://blog.drmalpani.com/2014/09/the-magic-of-vitrifying-ivf-embryos.html) . In an expert's hands, survival rates after freezing and thawing are nearly hundred percent. Even better, the implantation rate of thawed embryos is actually better than it is for fresh zygotes, because endometrial preparation is far more optimal. This means that every frozen embryo is worth its weight in gold, because it has such a potential to implant and become a baby, especially when it is a blastocyst.

However, a lot of patients don't freeze their embryos, even though we encourage them to do so. In sense , they are abandoning their embryos, which is such a huge shame, because they are potentially throwing away their chances of having a baby.

 Part of this reluctance is because it's an additional cost, and it's perhaps a cost which they were not prepared for.  I always tell them that a bird in the hand is worth two in the bush - and if you get a bonus, you should take it. A frozen embryo is a great insurance policy, and transferring frozen embryos is much less expensive and much easier than doing another fresh cycle, which means it is a very cost effective option. Even if they do get pregnant in the fresh cycle ( something we can never predict) , their frozen embryos and still very valuable , in case they miscarry. And even if the fresh transfer does result in a baby, they can still use that frozen embryo for completing their family after a year or 2.

If you are lucky enough and do have high quality blastocysts to freeze , please make sure that you vitrify them. It's well worth the additional cost !

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