Does your IVF clinic follow best practices?

Most IVF patients are pretty clueless when selecting an IVF clinic. They naively believe that all clinics are pretty much the same. This can lead to disaster when they go to a poorly equipped clinic - one that doesn't have enough experience or expertise . These clinics take lots of short cuts - for example, by depending upon " travelling embryologists " to do IVF for their patients, because they don't have in-house full time expert embryologists. That's why you should understand what IVF best practices are , and check whether your clinic follows these, before actually paying the money for your IVF treatment. Once you start your IVF cycle, this is a sunk cost , and you are stuck.

What are the best practices you should look for ? These can be checked at the time of the first consultation. Good IVF clinics will create a treatment plan which is customized to your needs and share this with you; they will document what your medical problems are and explain to you what alternative solutions are available. They will also let you know what the costs and timelines are. During your cycle, they will  share information with you , and let you know what's going well, and what's not. They will show you your  ultrasound scans ; and give you photographs of your embryos before the transfer , so that you have complete documentation , and you know that the IVF clinic has followed proper processes. This will improve your chances of having a baby ! 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 you should insist that your IVF clinic does a Day 5 ( blastocyst) transfer for you

There's still a lot of confusion and controversy about whether it's best to transfer embryos on Day 3 or Day 5, especially in India. While most IVF clinics all over the world have progressed to doing blastocyst ( Day 5) transfers, many Indian IVF labs are still lagging behind, and lots of them still prefer doing Day 3 transfers - and some still continue doing obsolete Day 2 transfers.

This is not in the patient's best interest. The justification these doctors use is that the uterus is a better environment for the embryo as compared to the laboratory . They claim that if we have a good-quality embryo on Day 3 , then we should transfer as soon as possible. If it's going to become a baby, then it will do so , so why keep it outside in the incubator when it's safer inside the uterus ?

This is flawed thinking because the reality is that the best place for a day three embryo is not the uterus - it's actually the Fallopian tube. Putting it back in the uterus is not good for the embryos. In a good IVF laboratory, the best place for the embryo is the IVF lab rather than the uterus.  The uterus is the right place for the embryo only when it has reached the blastocyst ( Day 5) stage. This is why all good labs prefer doing Day 5 transfers !

However, the problem is that many Indian IVF clinics have poor-quality IVF labs, with a poor rate of blastocyst formation. Because they are  not willing to be honest with their patients, they make up all kinds of fairy tales that a Day 3 transfer is as good as a Day 5 transfer. Now it's not that you don't get pregnancies after Day 3 transfers - it's just that the pregnancy rate is much less as compared to Day 5 transfers. The problem is that in India it's easy to fool lots of patients a lot of the time, because patients are not well-informed and assertive.

These poor quality IVF clinics will often transfer many Day 3 embryos in order to get them to implant. This needlessly increases the risk of a high order multiple pregnancy. The advantage with a Day 5 transfer is that the ability  to select the best one is much better. This is why we need to transfer only 1 -2 embryos, as a result of which the risk of a multiple pregnancy is much less.  Another reason implantation rates with Day 5 transfers are better is because we have optimized the synchronization between the blastocyst and the uterus lining . This is because the best stage for an embryo when it reaches the uterus is the blastocyst stage , and not Day 3. Also, we are not wasting any embryos, because we freeze the extra blastocysts , and can use them for future cycles

The problem with these bad IVF clinics is that they know that their labs are not very good . They don't have much confidence in their ability to grow embryos to blastocysts, which is why they start taking shortcuts. Now, if you have a bad-quality lab, then I think it makes sense to put Day 3 embryos back in the uterus, because if you leave them in the incubator, they may arrest in vitro, and not form blastocysts, because the embryologist is not skilled or experienced. However, you must understand that this is a compromise. If you are going to a good-quality IVF clinic lab, then make sure that you insist on a day five transfer.  This is better for everyone.

One of the fears patients have is that their embryos may look fine on Day 3, but they may not form a good-quality blastocyst on Day 5. Yes, this can happen even in a good lab - for example, in older women , or women with poor ovarian reserve, but this is actually very valuable information because it help us to diagnose that there is a problem with egg quality.

We know that the energy for embryo cell division is provided by the mitochondria which are in the cytoplasm of the egg. Today, there is no test to check the quality of these mitochondria, which is why the ability of the embryo to divide well and form a good quality blastocyst in the laboratory gives us such valuable information as to the functional competency of the eggs. If you put in a Day 3 embryo and the patient doesn't get pregnant, we are never sure what the problem was. Was it that the embryo failed to continue to develop further? Or, was there some other reason? The patient remains in the dark after suffering the horrible two-week waiting period . She is no wiser and doesn't know what to do differently the next time.

The problem is that when many Day 3 transfers fail, the doctor then conveniently labels the patient as having a recurrent implantation failure , whereas the truth is that the failure is because of poor-quality IVF lab conditions.  A poor lab creates suboptimal conditions , which stress the embryo, and cause it to stop growing after the transfer, because they have been subjected to needless insults in vitro because of inexpert handling by the embryologist.

These are the patients who are then told to go in for surrogacy ! This is absolutely the wrong choice for the patient , but is far more profitable and remunerative for the clinic to offer this option.

An IVF cycle can provide invaluable diagnostic and prognostic information, and the best way to get this is by insisting that all embryos be grown to day five before they're transferred . This offers a lot of clarity, and reduces doubt because you can see the quality of your blastocysts for yourself .

What happens if you're stuck with a bad IVF lab?  This is truly tragic, because you have reduced your own chances of getting pregnant. This is why you need to do your homework in advance, and make sure that your clinic does only blastocyst transfers .

While it's true that if the embryos arrests in vitro before forming a blastocyst, this can be heart breaking, because we then don't have anything to transfer. However, if it does arrest, it gives us useful information for planning your next cycle.

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 become a tech-savvy doctor

How to become a tech-savvy doctor from Dr Aniruddha Malpani

Ecofriendly organic farming at the Malpani Trust, Bajwada, MP

Why do doctors subject IVF patients to such rubbish ?

These are the medications a reputed IVF clinic puts all its patients on routinely after embryo transfer. 

A text book example of irrational prescribing and polypharmacy !

No wonder patients get fed up of doing IVF treatment.

Apps smart doctors should be using for their smart phones

Apps smart doctors should be using for their smart phones from Dr Aniruddha Malpani

Can entrepreneurship be taught ?

Entrepreneurship has become fashionable and the startup space has become hot . It you're young and ambitious, you no longer just want to work for a large company - you would rather become the founder and CEO of your own company .

All this is fine, but the question is, "Can you actually teach entrepreneurship? Is it possible to create entrepreneurs? Are entrepreneurs born, or can they be made ?"

The startup space has become the newest bandwagon , and everyone wants to get on. This is why you see lots of incubators and accelerators , which promise to teach young founders how to become successful entrepreneurs. Even the IIMs have got into the game , and have started offering courses on learning entrepreneurship. These are also available online, from leading universities such as Stanford.

This brings us back to the question, "Is entrepreneurship something which can be taught?"

I think it's a bit like leadership. It's one of those intangible qualities, where everyone wants to create leaders , and everyone wants to be a leader themselves, but is it possible to actually teach someone how to become a leader?

It's not that people haven't tried ! There must be at least a thousand books on how to become a leader , lots of whom have been written by icons who've been leaders themselves. However, I don't really think reading books, attending MBA courses or attending workshops will helps founders to succeed.

The only way to learn is by experiencing the daily grind of a startup, so you understand the ups and downs you will have to cope with daily. It all looks very rosy from the outside, but the reality is far grimmer. Yes, some people who graduate from accelerator programs will become successful entrepreneurs, but often this could be in spite of the training - not because of it.

The best training is still the 'School of Hard Knocks' - and if you want to be a successful entrepreneur, plan to work for a startup , and then start up you own once you are confident you will be able to survive the emotional roller coaster ride.

I believe entrepreneurship cannot be taught, but it can be learned - and when the student is ready, the teacher will appear !

The Indian startup ecosystem has matured

A mammal reaches maturity from a biological perspective when the female of the species is capable of reproducing. The startup ecosystem in India has reached maturity as well using this metric, because we're seeing that people who have worked in the first generation of IT startups in India - companies such as Infosys, Justdial and Naukri - are now starting their own startups. Even better, the founders of these companies are new acting as angels and mentors to fund and kick start the next generation of entrepreneurs.
This is a very healthy trend and it's great to see that we are evolving in the right direction, rather than going extinct. This is the way both capitalism and biology work.

An entrepreneur is someone who takes intelligent risks, and because these employees have worked in companies where the founders have taken risks and been successful, they have a mental model of what makes startups tick. They have graduated from the School of Hard Knocks, and have experienced first hand the need to be frugal and resilient when creating new business models . They are now applying these lessons to starting their own company, because they are ambitious and want to create their own success story. They have the courage to step out on their own , so that they can leave their mark in the world.

Lots of observers bemoan the fact that it's hard for entrepreneurs to get funding in India today. They keep on comparing the Indian ecosystem with the one in Silicon Valley, or in Israel. I think this is naive. Silicon Valley has taken decades to get to the stage it has, and we are headed in the right trajectory. It's not fair to compare an adolescent tiger cub to a fully grown adult. I think we will catch up and leap frog quickly because the stars seem to be aligned, but we need to be patient, and cannot expect overnight successes. It's these unrealistic pressure for quick returns which is actually causing founders to burn out because they've burned cash too quickly in their unrealistic pursuit of growth at any cost. It's stupid to try to blindly ape the West - we need to play to our own strengths.

I am very enthused by the fact that the ecosystem is growing in both breadth and depth. The successful founders of these first generation ventures have reinvented themselves as mentors and angel investors for the next generation of founders. Because they've been through the grind themselves , they're a lot more empathetic. They are able to support the entrepreneur in his time of need because they've been there and done that. They also have a great network , and can open up their Rolodex to help new entrepreneurs to succeed. We still don't have a PayPal mafia in India, but I am sure we will see a homegrown version in a few years.

I think this will now become a positive virtuous cycle , just like it has in California , because success breeds success - we just need to give it time. There seems to be a confluence of factors which bodes well for the startup ecosystem, if we have the maturity to take a long-term perspective. Startup investing is becoming an established alternative asset class, which is attracting funds from high net worth individuals, which means there is a lot of domestic financial capital to fuel this growth. This is a great way of passing the baton on to the next generation of founders.

My biggest concern is that in our quest for creating Indian unicorns, we may lose sight of the fact that the unicorn is a fabled beast, as pointed out by James Thurber. Instead of pursuing mirages, we should focus on creating solid, stable businesses, which will grow organically because they are profitable.

The e-commerce debacle in India

When the traditional value investor looks at the financial statements of e-commerce companies such as Flipkart, Amazon, and Snapdeal, he's forced to rub his eyes in disbelief. Even though these companies are burning cash and losing money hand over fist, they keep on spending on advertising in order to acquire new customers.

This seems to defy all business logic. They are actually losing money on each order, and yet they want to acquire even more customers so that they can continue losing even more money? What business sense does that make ? When is this madness going to end? Do they ever plan to make any money? How and when ?
Sometimes you feel as lost as Alice in Wonderland must have been. If these CEOs are able to raise millions of dollars from VCs , they must be very smart, which means there must be something in the big picture which you are missing. After all, the mysterious ways of VCs who distribute millions of dollars are beyond your limited comprehension . This is why the average observer is forced to conclude that what's happening in this space is beyond his understanding.

We all agree that VCs are the financial wizards of the world , and are much smarter than you and me. They must see value in these companies, which is why they continue funding them.

   The standard explanation is - " this time it's different" - famous last words which older investors have heard many times in the past . However, sometimes you wonder whether the Emperor has any clothes . This is especially true for senior citizens, who heard very similar stories during the internet dotcom boom days.
   In one sense, the dotcom bust validated some of their concerns, and they can't understand why VCs have such short memories , and why they are willing to make the same mistakes all over again. Perhaps this is because this is a younger set of VCs, and institutional memory is short .

The problem is that most of these companies are copy and paste clones who don't have much of a moat. Because they are fighting so intensely for the loyalty of the small fraction of wealthy Indians who can afford their services, they're bleeding to death competing with each other.

   I'm not a fortune teller, and I can't predict when it will end ; or who remain standing once the circus stops. Obviously, the survivors will do well. However, even this is not guaranteed, because the moment you become the dominant player, there will be a new cohort of startups who will come and challenge you - this is what keeps the cycle of creative destruction going.

The winner in these battles was the Indian consumer , who benefited as a result of all the freebies and the cashback offers which these companies offered. Effectively, we have seen a net transfer of wealth from the VCs to the smart cost-conscious Indian consumer hunting for bargains. This is not sustainable, and something has to break.

When it does collapse, then we can all look wise and say, "I knew this was going to happen" , and " I told you so ! " The bottom line is that companies cannot afford to ignore unit economics and profitability for ever. While gimmicks such as full page ads and discounts can fool some of the people some of the time, they will not allow us to create a sustainable business.

Part of the problem is that this is such a hypercompetitive space that it's easy to find a greater fool, which is what allows VCs to keep the valuation game going . When it reaches unrealistic levels, it's a question of waiting to see who comes to their senses. However, because there is so much money at stake , VCs will wait to see who blinks first in order to protect their reputation, rather than acknowledge they made the wrong bet. They are riding a tiger from which they can't get off.

So was all this VC money wasted ? While some VCs will lose money, they are big boys who understand that this is part of the game , and they will bounce back. The good news is that this funding has had salubrious effects on the Indian economy. It introduced lots of Indians to the convenience of online shopping , and because it made digital payments popular , the government now finds it easier to get citizens to move towards a "less-cash" India. The companies also catalysed the creation of a robust supply chain, which delivered goods reliably to people living in Tier 4 cities. Finally, they have helped to stimulate the growth of the startup ecosystem in India . Thanks to the media adulation the founders of these companies received, they have become heroes for the young, who now aspire to follow in their footsteps - they have made entrepreneurship fashionable !

Using dashboards to manage your startup

Every startup is an experiment and the reality is that most of them fail. This is because they're complex systems with multiple moving parts, all of which have to work properly to make sure that the company continues to grow. This can be extremely challenging for the founder, who has to juggle multiple balls , and make sure he doesn't drop any of them. This is daunting task, because you need to learn on the job - which is why it's very hard to know whether you're on the right track or not. Are you chasing the right customers ? Is your product delighting them ? Is your competition catching up with you ? Will you be able to find investors to fund your next round ? It can be extremely hard to track all this stuff, especially when there is so much uncertainty , and it's easy for things to fall between the cracks.

Because there are no pat formulas you may find yourself disagreeing with your investors - for example, if you should go international , or whether you should stay in India. The only way to find the right answers is to run low-cost experiments, and track the results, so that you become progressively smarter. This is why tracking the key metrics is vital - so you can quickly see if you are on the right track or not.

Most founders use Excel to monitor their company's vital signs, but a dashboard can be much more helpful.
The secret is to follow open management principles, and keep an online dashboard which is accessible to everyone . This way, all employees can see how the company is doing; how it's progressing; what their personal contribution is; and what they need to do to make sure that the company continues to grow. It's far better to put it all out in the open, even when things aren't going well. You may be worried that this will affect morale, and that your staff will quit, but the truth is that most of them can sense when the company is doing badly, and they are already worrying anyway. It's far better to acknowledge this, rather than try to hide the truth from them, because this just makes matters worse. Being open about it will help to dispel rumours and gossip; and will reassure them that you have a plan of action to deal with the crisis. Even better , it will bring them all together and help them to pitch in , so that you can tackle the problem as a united team - there is strength in numbers , and employees should be empowered to provide solutions !

The dashboard should be simple, and should focus only on a few key metrics. You need to define what these are, because they will vary from company to company. You will also need to modify them as your company evolves. The beauty is that a dashboard creates a sense of ownership amongst all your staff.

As a CEO, your dashboard allows you to check how you've progressed; and whether you're headed in the right direction or not. You can set up access privileges, so if there's some information which you think is confidential (for example salaries ) , then you don't need to put that up on the publicly accessible dashboard.
Even better, a dashboard allows you to share information with your investors proactively , without your having to do any additional work. They will be happy to provide support and insights when they can see you are treating them as partners in your journey.

A dashboard can be a very useful tool, and you should explore the available options. The standard is www.geckoboard.com, and there are many inexpensive alternatives as well , such as http://finalboard.com/. You can use also the open source JSlate code at https://github.com/rasmusbergpalm/jslate to create your own free customised dashboard as well.

As a startup founder eloquently said, " Without a dashboard, running a startup is like flying a plane through fog with no instruments. " Life as a founder is hard enough as it is - why handicap yourself even further ?

Why are doctors getting burnt out ?

The general perception is that doctors are extremely hard working. Most patients both admire how busy doctors are and resent this as well - especially when they have to wait for hours to see them. Because they are so rushed, they don't have enough time to listen to their patients, or to explain the basics properly to them. Most doctors seem to always be running around from clinic to clinic, and hospital to hospital . Even a doctor's own family members resent the fact that his life is so stressful because he always seem to be on the go, and is on call 24/7.

While it is true that good doctors are extremely busy because there's always going to be a lot of demand for skilled doctors, the fact of the matter is that one of the reasons why many doctors are so overworked is because they don't manage their time very well.

It's true that some of these problems are out of the doctor's control. Thus, if you work at a government hospital where you need to see over 200 patients in the clinic in 2 hours, you really don't have a choice , because you have to see all of them. However, sometimes these problems are self-inflicted.
This is especially true for doctors in private practice who run around from one clinic to another , simply in order to maximize their income . They are very competitive, and want to set up clinics in many different suburbs, because they feel they need to go to where the patients are in order to grab patients from other doctors. This is why they spend so much time stuck in traffic, commuting from one clinic to another. What a waste !

Instead, if they chose to focus on just one clinic and waited for patients to come to them, they wouldn't be so needlessly " busy" because they wouldn't be wasting their precious time. Not only would this be much better for them, it would be much better for their patients as well. A happy, contented, stress-free doctor is going to be far more compassionate and empathetic than one who's running around all the time.
This is something which doctors need to learn - how to say no. They don't have to keep on seeing more patients every single day; and they don't need to compete with their colleagues to find out who's the richest or the busiest. They need to be able to find the right work-life balance, rather than participate in a mindless rat race.

Even in a government hospital, the doctor needs to learn how to delegate, so that his juniors can screen patients. Part of the problem is that most doctors are not good team players. They feel that they have to do everything themselves, as a result of which they end up micromanaging their staff, and doing stuff which ideally they should be getting either a junior doctor or their secretary or their receptionist to be doing. It's not necessary for a doctor to do everything himself from A to Z. The administrative tasks - for example, issuing receipts; collecting payments; giving appointments; and doing follow up calls are best entrusted to a junior doctor or an assistant. This will free up the doctor's precious time, so that he can focus on doing the one thing which he does the best - taking care of his patients.

This unproductive use of his precious time ends up hurting him as well, because he feels professionally unfulfilled. This is one of the reasons burnout has become such a huge problem among doctors today.

The truth is that a lot of their work is just "busy work" , which they shouldn't be wasting their time doing, because it's best done by someone else on their team. Sadly, doctors continue getting away with their inability to manage their time properly, because their patients put up with this. Let's not forget that doctors can make patients wait for hours on end only because their patients allow them to do this to them. If all of them refused to accept this disrespectful waste of their time, the doctor would be left with no patients to see, and he would be forced to improve his behaviour very quickly !

The good news is that doctors can use technology intelligently in order to make sure that the time they spend with their patients is utilized effectively. Instead of being extremely busy and accomplishing very little, they can use their time productively, efficiently, and effectively. There are lots of productivity and time management tools which will help them to do so , but unfortunately most doctors don't learn how to use these.

The IVF patients quandary

We recently treated a patient who presented an interesting dilemma. She'd done IVF at the age of 38 because she was worried about her poor ovarian reserve and hadn't got pregnant even after four years of trying.

We did an IVF cycle for her. We got three grade A blastocysts. We froze one, we transferred two. She got pregnant, and now she has a gorgeous one-year-old daughter.

She is now 40 and she's not sure what to do. She's wondering whether we should transfer the remaining one frozen blastocyst which we have, which is actually a great quality blastocyst, but she's not sure whether that will achieve a pregnancy or not.

Her other option is to keep this one in reserve and then do another fresh cycle, given the fact that it's only been a couple of years since she does her last cycle and hopefully ovarian reserve hasn't dropped too much and this way her hope is that she will get pregnant in the fresh cycle, and even if she doesn't she may be able to generate some more frozen blastocysts so that she'll be able to have a better chance of getting pregnant in case the fresh cycle fails.

Now this is an interesting dilemma. The frozen blastocyst which we created when she was younger obviously gives her a good chance of getting pregnant, and perhaps better than one with fresh blastocysts at the age of 40, but it's very hard to be able to make some of these decisions, both for the patient as well as for the doctor and I think sometimes it's better to be safe rather than to be sorry and I agreed with her that we should continue storing this blastocyst as a backup measure and we can always use it if required, and we should do another cycle for her rather than wait because if she does transfer the frozen blastocyst and she doesn't get pregnant, then she'll be that much older before she can do another fresh cycle.

This story exemplifies the fact that there are no straightforward black or white answers in IVF - patients need to decide for themselves , so they have peace of mind they did their best !

My IVF success story

We can't thank Dr. Malpani and team enough for what they have given us. Their efforts and dedication towards their work and patients is beyond words. We we're amongst those few who were trying to carry a beautiful life but would fail everytime. 2 years went by and almost lost hopes. Then we were going through online and came across Dr Malpani's blogs. His blogs were so practical and realistic that nothing could stop us from meeting him the very next day

When we meet him there was no looking back. There so much positivity in him that he gave us a positive outlook towards our entire situation which we were stressing about for 2 years. We decided to take our IVF treatment from the him immediately. Today I am happy to announce that I am carrying a beautiful baby in my womb.

All thanks to Dr Malpani and his team who have always been upto the mark with the entire treatment, followed up so well always guided me right and took care of all our needs promptly. Constant follow up was done even after the procedure. Lastly all I can say is they took utmost care of me and made me very comfortable.

Thank you Sir, You truly are a blessing !

Scientific quackery in IVF.

When we think of quacks, we think of unqualified doctors holed up in dingy rooms in slums and villages who give colourful injections, herbs , placebos and potions to illiterate patients .  We believe that it's easy for them to fool illiterate poor patients, who don't know any better; and that we are safe, because we go to sophisticated doctors who practise in gleaming 5-star hospitals.

However, quackery is far more prevalent than you realise, and lots of highly qualified medical specialists engage in quackery  as well. They label it " cutting-edge treatment" , but the truth is that a lot of things which many specialists prescribe do are not scientifically sound. They are not based on evidence-based medicine, and are really quackery in disguise, because they remain unproven. Just dressing it up in medical jargon doesn't change anything !

They take their patients for a ride by telling them that this is the newest and latest advance, which is why other doctors do not prescribe it - the impression being that other doctors are hopelessly obsolete and clueless.  They harp on the fact that this is the most modern technology, without explaining to patients that it has never been subjected to controlled clinical trials ; and never been documented to be useful by objective medical professionals.

Lots of IVF specialists use their patients as guinea pigs, in the sense they base their treatment plan on personal anecdotal success stories. Because patients are very emotionally vulnerable, they don't ask too many questions. Most are scared to challenge their doctor, and they pretty much toe the line blindly - after all, isn't their doctor a world-renowned expert ? He knows what he is doing, so aren't they supposed to do what the doctor tells them to?

Sadly, this unquestioning trust often backfires.  We've seen many patients who have wasted years of their life on toxic anti-TB treatment for " endometrial tuberculosis" ; have had unnecessary surgical procedures like a hysteroscopic metroplasty performed on them to correct an uterine cavity whose shape is slightly different ( but is completely normal) ; and whose husbands have taken all kinds of treatments for improving their sperm count. These "treatments" don't work - and actually reduce their fertility, because they end up wasting their time, money, and energy. They no longer have any confidence in any IVF doctor because of their bad experiences.

This is why so many IVF patients have such a poor opinion about IVF clinics. It's not just the fact that their  IVF treatment failed - it's that a lot of it was done without adequate counselling or explanation . When they finally get around to seeking a second opinion , or doing some independent homework for themselves on the web at reliable sites such as the Mayo Clinic website, they realize that they were subjected to lots of unnecessary, very expensive treatments which were never called for in the first place.

What really upsets them is that the doctor not share the truth with them. If the doctor had been upfront and honest and said, "This is experimental treatment which has not been proven, but I've had good success rates with it, which is why I think it's worth trying," then that's completely different.  Sadly most IVF doctors don't have the time to explain things properly to their patients. They tell the patient what they do, and they expect that the patient will obey them blindly, without asking too many awkward questions. This is why IVF quackery continues to flourish.

Yes, you should trust your doctor, but please verify from independent sources whether his advice is medically sound - you have too much at stake !

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 lazy farmer's guide to sustainable agriculture

All of us understand the central importance of nutrition in our lives . We know we need to eat good quality food if we want to lead a healthy and happy life.

However, because of our multi-billion food processing industries , we end up stuffing ourselves  with poisons which end up killing us faster. This is why there is such a great demand for organic foods, which are not contaminated with chemicals. However, the problem is that organic foods are seen to be exotic and expensive.

We need to look at alternative options which make organic farming a lot easier , cheaper and more convenient than traditional farming.

The problem with farming today is that it is based on a western model which involves a lot of mechanization.  We want to copy the West , because this is where most of our agricultural technologists and farm scientists train. This blind copying and pasting has ended up causing us a lot of harm , because it's completely inappropriate for Indian conditions .  We don't respect our farming traditions , and ignore the wisdom of our farmers.

Indian farms are tiny, and are owned  by marginal farmers who struggle daily to make a living from the produce they can coax from their lands. Many of them fail,  because of the harm they have caused to their soil by using the fertilisers, chemicals and pesticides which they have been taught to use.

Sadly, they don't know any better , and because these are quick fixes which increase yield on a short term basis , they go ahead and employ these measures. Unfortunately , they don't understand the harm this causes to their soil . The long term yield of the land takes a beating, and the poor farmer gets progressively poorer because he needs to keep on pumping his soil with lots of additional fertilizers, chemicals and pesticides in order to make a living.

The good news is there are now alternative ways to improve yield, and this is where Natueco farming comes in. The beauty about this model is that the farmer allows Nature do all the work.

The growth of crops in our fields is one of the bounties nature has blessed us with, and any one who tends their own garden will agree with this.  It's only when we try to increase yields because we think we're smarter than nature, we end up increasing short term productivity , but causing long term harm.
Sadly, most of are too short sighted to realize this , because it can take a few decades to understand the harmful impact of  modern farming practices.


The real beauty of Natueco Farming is that the farmer only needs to work once in his entire life order to create the amrit mitti - after this , nature takes over. Since all of human life depends on solar energy, natueco farming allows us to intelligently trap this energy , so that we can convert it into organic food which is safe and abundant.


India used to live in its villages, but because agriculture has become such a hard way of earning a living, lots of farmer's children are now migrating to the cities. This is because they believe that
farming is very labor-intensive ; and that because farms have become so small, the poor marginal farmer cannot survive on the small parcel of land which he owns.

These misconceptions need to be cleared. It's true that traditional farming involved back breaking labor, but this is because it was done the wrong way. The trick is to use Matueco Farming and let the sun do all the work !

This might sound startling, but the fact of the matter is that nature is able to grow huge trees in her tropical forests  without any human intervention.  The solar energy which is trapped in the leaves is sufficient for creating very dense forests, without any labour.  Natueco Farming teaches farmers how to learn from this.

The trick is to treat the soil kindly and to respect the sun. The trouble is that agriculture is riddled with myths . We believe that Indian soil is infertile, and that we need to pump it with fertilizers in order to improve soil productivity. Farmers are taught to spray their plants with chemicals and pesticides in order to protect them from insects.  We need to stop and think. We don't pump our children with antibiotics and chemical supplements to keep them healthy. We just give them a nutritious diet and help them to exercise, and they grow up into healthy adults. We need to treat our soil in exactly the same way - with respect and with trust.

The truth is that the marginal farmer can be profitable , provided he learns to incorporate sensible organic farming practices . He needs to stay away from the commercial pressures to use pesticides and fertilizers. This model is called Natueco farming. The beauty is that once the farmer does the work of creating the amrit mitti ( which takes about 3 - 6 months) , he can reap the fruits of his labor for the rest of  his life. The secret lies in doing as little as possible - he uses natural biomass in order to make the soil even more fertile, so that it actually improves year after year !

The problem today is that farmers end up raping their soil because they want short-term fixes. They don't even realize the harm they do.

There's a lot of scientific proof of the efficacy of Natuceo farming, which is uniquely suited for the small Indian farmer. We can allow the results to speak for themselves, and if one picture says a thousand words, here's an image of the organic farm we run in MP.

Part of the problem is that this technique has never been marketed properly. Because there is no commercial agenda in promoting it, people do not recognise how valuable it is.  The good news is that this is all open-source wisdom, and we're happy to share this knowledge with everyone to make the world a better place !