Does your IVFclinic offer xxxxxx treatment ?

One of the commonest questions patients ask us is - We read about the following advanced treatment option on google. Does your clinic offer this treatment ?

Now we have been doing IVF for over  25 years, and have seen many fashions and  fads come and go.  Yes, IVF is a science, but it is afflicted by lots of  hype as well, as clinics compete with each other to offer the "newest, latest and best" advance to their patients !

The additional advanced " tests and treatment" patients want depends upon their educational sophistication, and varies from:
-  ERA - endometrial receptivity assay
 - CAT - cumulus aided transfer
- PGD - preimplantation genetic diagnosis
- Endometrial scratching
- PRP - platelet enriched plasma
- Stem cells

Patients need to retain their sanity and their perspective.

Remember that not all new treatments are better  - many of them are still unproven, and best used in a research setting, because their clinical utility has not been established by controlled clinical trials.

Also, doctors fall in love with "shiny new object syndrome" and love trying out new stuff - not because the patient benefits, but because their bank balance does  - after all, you can always charge more for doing   more !

Doctors play a oneupmanship game, and it's their patients who suffer !

It's easy for us to offer these "add-ons" as well - after all, we are a fully equipped IVF lab, and can do what any other clinic does - we have the expertise, equipment and the technology to do so . The reason we don't is because we are conservative , and don't want to use our patients as guinea pigs. We don't want to experiment on them, and would rather wait for well done research to provide that an advance was clinical useful, before offering it to our patients. We aren't in a race to be the first for unproven tests and treatments !

Remember that if these advances were really useful, then all clinics all over the world would start offering them routinely, and the reason they don't is because a lot of these unnecessary procedures don't help. In fact, some have been proven to reduce pregnancy rates !

You can read more about this race to do more and the harm it causes patients at http://www.drmalpani.com/knowledge-center/infertility-testing/wasteful-infertility-tests

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 IVF embryoscope scam

Many IVF clinics are in a technology arms race. They want to play the game of one-upmanship, by boasting that the have the "newest and latest" technology, which makes them better than the other clinics.

While this is a great marketing ploy, the tragedy is that many clinics take naive patients for a ride, by claiming to use technology when they don't actually do so .

To add insult to injury, the charge a bomb for doing procedures which they never did !

The poor patient is clueless, because they have no idea what goes on inside the 4 walls of the IVF lab, because these doctors refuse to share information.

Thus, there are clinics which claim to use an embryoscope. Now, this is device which allows the embryologist to take videos of the embryos while they are growing inside the incubator , which means the doctor should be able to provide photos of the embryos to the patient.

However, these labs don't do so , because they don't actually use the embryoscope - and just claim to do so !

If you want to make sure that your doctor is not taking you for a ride, please insist that they give you photos of your embryos. If they don't do this routinely and proactively, this means that they may be lying to you, so you need to beware !

Not sure if your IVF clinic is playing games with you ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Times of India public awareness campaign to remove social stigma around IVF

This is part of their Fertile Conversations campaign to demystify IVF, and is being sponsored by Nova IVF

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 !

Fertile Conversations ! A Times of India Fertility Awareness Campaign

I am very glad to see that the Times of India has taken the initiative to create more awareness about infertility by launching a campaign called Fertile Conversations

This is a combined, print, online and real world campaign.

It has been sponsored by Nova IVI, a chain of infertility clinics in India, which means the primary purpose of the exercise is commercial - to promote their practise by getting infertile couples to come to their clinic for treatment by driving traffic to their website and their free events.

While this is a great way for Nova IVI to acquire more customers, the good news is that it's also encouraging more people to start talking about  what used to a taboo topic, which still carries a lot of social stigma in India.

Hopefully, having open conversations will encourage infertile couples  to reach out for help, rather than bottle up their angst and frustration, and this is all for the best. . It's something we have been doing free of cost for many years, and I am glad other clinics are now following in our footsteps !

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 !

Times of India article on infertility

Dr Malpani, however, offers a different view. "Victim blaming is a big issue across India. People tell women that they are unable to conceive because they don't eat healthy or work too much. It is unfortunate that women feel stressed and inadequate due to the inability to have babies,'' he says. "I have had women crying and asking if they are too fat or if the anti-acne medicine they used previously is responsible for infertility .''

http://timesofindia.indiatimes.com/city/hyderabad/why-more-and-more-indians-cant-have-kids/articleshow/59587740.cms

How patients get taken for a ride !

I've noticed a disturbing trend these days. For-profit healthcare companies, clinics and hospitals are advertising direct to the public - either on hoardings, or by taking out full page ads in newspapers. They promise the equivalent of a miracle cure - and one of the most fashionable trends these days seems to be to use platelet-enriched fractions of plasma. These are  used for all kinds of treatments, from head to toe, depending upon the specialisation of the doctor. Neurosurgeons inject it in the CSF ( cerebrospinal fluid) to treat autism; trichologists inject these in the hair follicles to treat baldness ; and orthopedic surgeons inject these in the joints to treat arthritis. The fact that these are used anywhere and everywhere itself should make them suspect !
Let's look at just one area today - treating aching joints. These elixirs are supposed to regenerate aging joints and make them as good as new, so that patients don't have to undergo knee surgery. This is a tempting prospect, and the tragedy is that many patients get suckered by this kind of advertising.  The bigger tragedy is that there is no one to protect these patients !
A lot of these companies make all kinds of tall claims. Painful knee joints are very common, and because people are reluctant to undergo surgery, most of them are quite happy to try out these treatments, because they're non-invasive, and are marketed so cleverly. It's quite logical to believe - " Why not try it and see? What do I have to lose ? "  And the truth is that some patients will benefit, which will keep the buzz going. Every treatment has a placebo effect, so that even if it is completely useless, some lucky patients will definitely benefit from it.
    The problem is that none of these claims have ever been proven to be true. They sound scientifically plausible, because they talk about " bioactive growth factors" , and they claim that this is backed by sound scientific research.
But guess what? All this research is usually published in poor quality medical journals, who will be happy to publish any rubbish if you pay them for it. This is what breaks my heart - that patients are so gullible , that they're willing to accept all these ridiculous claims.
Part of the problem is that patients naively hope that the government will put a stop to all these scams, and we all know how inefficient the Indian government is.  Patients also expect the medical profession to regulate itself, but sadly this is not going to happen. There is a lot of money at stake, and doctors don't want to speak up against other doctors, because of their code of "professional ethics" .
Patients need to learn to protect themselves, because no one else is going to do this for them, which is why they need to learn to stop and think critically.
If this was really such a big breakthrough, then don't you think any researcher worth his salt who came up with this innovation would be happy to publish it in a reputable medical journal, such as the Lancet or the New England Journal of Medicine? After all, this publication would establish his professional reputation for the rest of his life. If he was sure that his results were trustworthy, then we would take the time and trouble to perform a controlled clinical trial; document his results; do the research stringently ; and get it peer reviewed. Once it was published in a world-class journal ( and any journal would be happy to publish such ground-breaking research) everyone would look up to the researcher as having come up a significant medical advance - the ultimate badge of honour for any doctor !
    The very fact that none of these papers have been published in these leading medical journals itself should tell you that something is rotten in the state of Denmark ! Please don't get cheated or swayed by some of the rubbish these clinics trot out, just because it is very cleverly dressed up in a lot of scientific garb. Patients need to beware and you cannot afford to leave your common sense at home. You need to be on your guard, otherwise you will end up harming yourself.  Please don't allow doctors to take you for a ride !

The latest scam in IVF

It breaks my heart when I see all the scams IVF clinics use to cheat their patients. They disguise these in fancy scientific terms, and take their patients for a ride, by subjecting them to expensive, unproven treatments.

They use their patients as guinea pigs - and  to add insult to injury, they charge them for this privilege !

The latest scan is the use of "platelet-derived growth factors"  to "rejuvenate the ovaries" and " improve the endometrium". Lots of new startups have designed many different clever terms ( "autologous platelet rich plasma, PRP"  and "platelet activating factor"  to describe the same rubbish.

They basically collect the blood of the patient, separate the platelets, and then infuse the "platelet rich portion" into the endometrium; and/or the ovaries. This is the latest magic elixir, dressed up as a scientific potion, which is supposed to improve the thickness of the uterine lining; and get the ovary to regenerate new eggs, because the platelets are full of nourishing bioactive growth factors. This is simple cheap and easy to do, and any doctor can start offering this highly lucrative treatment to their patients.

The " clinical trials" they carry out are published in dodgy poor quality medical journals, who will print anything for a price. This gives them the instant imprimatur of respectability !

Sadly, infertile patients are so vulnerable and desperate, that they will sign up for anything which the doctor tells them will improve their chances. Lots of companies are peddling these potions,  which doctors are very happy to promote, because they get a huge chunk of the profits for doing these procedures.

Such a shame !

Does it make sense to do a blastocyst transfer when you have only one embryo ?

This is a guest post from Dr. Sai, Chief Embryologist, Malpani Infertility Clinic Pvt. Ltd.

The biggest dilemma in IVF today is whether to transfer on day 2 or day 5, when we have only one embryo in the incubator.

When we have lots of embryos, the decision is very easy. We can sit back, culture the embryos beyond day 2/day 3, let the embryos compete and select the best ones for Embryo Transfer on day 5.
It keeps everyone happy - the patient, the doctor and the embryologist - since state of the art care has been provided.

On the contrary , when we do the transfer on day 3, we have a hard time selecting the best embryos for transfer, especially when we lots of embryos of the same quality. We arbitrarily select 2 or 3 embryos of the lot for the transfer, but are never satisfied and safe, as we always know that there is no guarantee that these would reach the blastocyst stage , no matter how good they look on Day 3.
 

We keep our fingers crossed for the 14 days post the day 3 transfer. If the beta HCG is positive and the patient conceives, we feel we hit the jackpot because we managed to select the right embryos, as they implanted.  But if it fails, we curse ourselves for not waiting and culturing the embryos till day 5.

So the best approach , when we have lots of Day 3 embryos, is to do a Day 5 Transfer, because blastocysts have a higher chance of implanting as compared to Day 3 embryos, since they have developed further. We can always freeze the spare blastocysts for future cycles.

 But what happens, when we have fewer Embryos?

Even with fewer Embryos, we feel the approach should be to transfer on day 5.

As we know , when we have fewer embryos, the possibility of freezing embryos is extremely low.  This is why we have nothing to lose when we culture the embryos till day 5 and look to transfer the best embryos. This is a better approach as compared to trying to hedge our bets by transferring some on day 2 or day 3 , and then trying to freeze the others for the next cycle.

For example:
If there are only 4 Embryos on day 2, all top quality, usually a defensive approach is to transfer 2 embryos on day 2 and freeze the other 2, in order to have another cycle.

The best approach would be to culture all 4 embryos till day 5, and then select the Best Embryo (Single Blastocyst) for transfer.  This way we actually increase the chances of conception . If we are lucky we might have a second blastocyst, which we can freeze for another cycle.
This way we not only increase chances of this cycle, but also have a gem for another one.

When we have only 1 Embryo, what should be the approach?

Even with 1 Embryo, the approach should still be to transfer on day 5.
With just 1 Embryo, one might feel, it's too risky culturing till day 5, as the embryo might get arrested at some stage and never reach blastocyst stage.

But we should not forget  that if the embryo fails to become a blastocyst in vitro (in incubator),  this means it would not have become a blastocyst in the uterus either , which means there would have been no point in transferring it on day 2 or day 3. We have just saved the patient the futile agony of the endless 2 week wait !

If fact , the advantage of culturing the single embryo till day 5 is that we can track its growth carefully, rather than just chuck into the uterus on Day 2 or 3 just to give the patient the satisfaction that we managed to get an embryo to transfer. Let's not forget that the patient wants a baby - not an embryo transfer !

If the single embryo becomes a blastocyst, all of us feel good, and we are hopeful about the result.  However, if it doesn’t become a blastocyst, this does cause short term heart break, but we haven't compromised the patient's chances, because this embryos would not have implanted even if we had transferred it into the uterus on Day 2 or 3, since it would never have formed a blastocyst in vivo either.

The other advantage of doing a day 5 transfer is that we know the fate of the cycle much sooner, as compared to doing the transfer on day 2 or day 3, where, we spend sleepless nights for 14 days till the beta HCG.

Yes, this requires a very high quality IVF laboratory and a skilled embryologist, and you need to make sure you select the best IVF lab for your treatment . There is a great feel good factor  in doing a day 5 Embryo transfer  for patients with only a single embryo, and good clinics will take pride in being able to do this !

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 !