Experienced IVF patients are the best guide to finding the best IVF doctor

It's often very hard for an IVF  patient to judge the technical competence of her IVF doctor, which is why they are forced to use surrogate markers - for example, the doctor’s bedside manner; or what they've read about the doctor in a newspaper article ; or perhaps in an ad or on a website when making these decisions.

Now, the best way of finding out how good or bad a doctor is, is by asking experienced patients. What does this mean?

This is a patient who's been through multiple IVF cycles at different clinics , because this patient knows a lot about IVF – not only about the medical details of the treatment, but also how each doctor is different , and what makes them better or worse , as compared to another.

Patients  have no ax to grind , and will tell you the truth , and not cover up anything. They understand your perspective, and are usually kind and empathetic.

In the past, you would have had to depend on the peer reviews of doctors , based  on what other doctors said about that doctor. However, these opinions are no longer very reliable,  because few doctors will say bad things about other doctors, because they are professional colleague. And in this day and age, where kickbacks and commissions are rampant, many will lie about the doctor’s skills, because they have a vested interest in referring you to someone who gives them a cut of the IVF fees !

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 !

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How much does an IVF cycle cost in India

IVF treatment is expensive, which is why patients will often doctor-shop, in order to find the clinic which offers the most cost effective treatment option.

Sadly, they will often get cheated. This is because clinics will often hide a lot of their treatment costs in the fine print, as a result of which patients are then forced to cough up tons of extra money in the middle of their cycle. They are helpless and vulnerable , and because they are trapped , they are forced to pay up. However, when they cycle fails, they are understandably resentful , because they feel they have been cheated !

Thus, in order to lure patients, many IVF clinics will advertise their IVF packages, by saying the cost is only Rs 25000. Patients are very happy to sign up, until they then find out that the costs  of blood tests, scans, medication, lab procedures , and embryo transfers are all extra, and not included in the Rs 25000 they have shelled out.

Commercial IVF clinics use this as a bait to attract patients, because they just want to maximise the number of cycles they do, in order to make large profits. The care is very impersonal and disorganised, because they follow an assembly line approach, with their goal being to treat as many patients as possible.

This is why you need to ask for an upfront , all-inclusive package cost, so you don't have any unpleasant surprises later on.

Need help in finding the best IVF clinic in Mumbai ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Most successful IVF centre in Mumbai, India

Mumbai is the medical capital of India, and Mumbai IVF clinics attract patients from all over the world, because we offer state-of-the-art medical technology at affordable prices.

Good IVF clinics routinely use the newest IVF techniques, such as blastocyst ( Day 5) transfers and vitrification to freeze and store supernumerary embryos.

More importantly, they are open and transparent. They respect the patient, and offer a detailed treatment plan, so patients know exactly what to expect. 

They provide photos of embryos routinely to all their patients, so that patients are reassured knowing they have receive high quality medical treatment.

Patients are able to get treatment that is at par with the rest of the world, but at less than half of the cost in western countries.

There are many high quality IVF clinics in Mumbai, and selecting the best clinic will allow you to maximise your chances of IVF success.

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 best IVF center in Mumbai

Every patient wants to go to the best IVF center - after all, IVF is an expensive treatment, so you want to choose the IVF center with the highest success rate, to maximise your chances of getting pregnant quickly.

Not all IVF centers are created equal, and there is a huge difference in the success rates  of the best and the others.

This is because the IVF laboratory is the heart and soul of an IVF clinic, but most IVF patients have no idea about how good or bad the laboratory facilities in the IVF clinic are.

Not only so the best IVF centers have state of the art equipment, they also have a lot of experience and expertise, so they can grow and culture your embryos safely, so they form top quality blastocysts in the lab before they are transferred into your uterus.

This is why patients from all over the world choose Malpani Infertility Clinic for their IVF treatment. We combine high tech with high touch, because we are a boutique IVF clinic which provides highly personalised care to all our patients !

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 !

Review of our first IVF cycle at Malpani Infertility Clinic

My husband and I went to a renowned mother-child hospital in the suburbs of Mumbai to seek fertility treatment since we had an issue of male factor infertility (low sperm count and morphology). As per the doctor’s advice (which matched what we had read ourselves), we decided to go ahead with IVF-ICSI since this would the best suited for our condition since a single sperm would be injected into a single egg, thus dealing with the low sperm motility issue. The specialist told us that my husband could give sperm deposits which would be frozen and pooled along with a fresh sample for best chances of embryos developing. We made one sperm deposit and got a call that the sperm count was very low so could not be frozen. Earlier when we were discussing the process, the specialist had told us about the possibility of donor sperm but I was very clear that I didn’t want to consider any other option before at least one attempt at IVF with my husband’s sperm since we were mentally and financially prepared to go through more than one cycle.

After the first sperm deposit, the specialist called me and asked me again if I would be willing to consider donor sperm and fertilise half my eggs with my husband's sperm and half with the donor sperm. In earlier visits as well, we had felt she was not very optimistic about our chances and kept highlighting the male infertility issue as affecting the quality and number of embryos. This period was quite stressful for both of us because we were thinking what the implications would be if we used a donor sperm etc.

We decided we needed to get a second opinion and by this time we had read the Malpani blog which highlighted certain inconsistencies in her treatment protocol. We scheduled a meeting at Malpani Clinic where Dr. Aniruddha Malpani heard us out and saw all ours reports. He was extremely encouraging and my husband felt someone could finally understand what he was going through. I still remember what Dr Malpani said when we asked him about the low sperm count, abnormal morphology etc he said “ yeah that’s why you’re here and that’s where we come in - since the sperm count is low we do an ICSI, if the count was normal why would you need us?” He said all that is needed is one sperm and one egg for an embryo to develop and my husband had 5 million of them! We read up more on the process (a lot of it on the Malpani blog and website which is a treasure trove of information!) and realised the main hero of the IVF story is the embryologist who picks the sperm to inject it into the egg after these have been retrieved from the mother. If an embryologist is not skilled, they will not be able to pick out the sperm and no matter how fancy the ivf clinic, the results would get affected.

We decided to switch our treatment to the Malpani clinic mid-way during our treatment (I was in the super ovulation phase) and even though we needed to travel from one end of the city to the other , we looked forward to our trips to Colaba. The entire journey from egg collection to transfer was very smooth. Like Dr. Malpani said, stress does not cause infertility but infertility does cause stress and when couples are going through so much it is imperative that an IVF clinic is a cafe place. IVF does not give guarantees but I think it is important for practitioners to be empathic and understand what patients go through. At Malpani Clinic, we did not have to ever wait too long for our scans (in the other hospital there were multiple times we could be waiting for 2 hours+ even when we were the first appointment of the day because the doctor was running late!). The entire team at the clinic is very supportive and you get personalised individual attention which is so much better than the artificial, impersonal nature of hospitals. Another thing we really appreciated was the transparency and organised way the entire process was handled each time we visited. Dr. Aniruddha informs us about the procedure, Dr. Anjali does the scans, retrieval of eggs and transfer of embryos and the nurses explain the procedure to us again along with details of medications etc. Dr. Sai is the embryologist who is in touch with us regularly as the bros develop and send us daily updates via email as well. IVF is a journey which requires financial and psychological commitment and the team at Malpani clinic understands this very well. The payment structure is very clear without any hidden costs and explained right at the beginning:

You pay for the following:

1.         IVF-ICSI procedure (includes scans for monitoring  follicle development and egg retrieval)

2.         Freezing of embryos ( if you are doing so)

3.         Transfer

In the other centre, every time we went to meet the specialist we would have to pay for consultation, the scan and then there would have been the actual cost of the IVF procedure, freezing, transfer etc! So if I were to add it all, Malpani is more affordable without any hidden costs - why go anywhere else??!

At the end of our first cycle, we had two good grade blastocysts which we froze. The other specialist was not sure of how many embryos would develop till blastocyst stage and said we would be lucky to have 4-5 Day 3 embryos and it would be unlikely that we would get any grade A embryos. With Dr. Malpani and Dr, Sai we had 7-8 embryos on Day 3 out which 3-4 were Grade A.

We do not know if our first cycle of IVF will be successful or not (we have done the transfer and are currently in the 2WW) but I do believe that our treatment with Dr.Malpani is our best shot at having our own baby!

We wanted to write this review for mainly two reasons:

First, as a thank you to the entire team at the Malpani Clinic for a wonderful first cycle. It was scary not knowing what lay ahead but all of you made the journey very smooth for us. My husband was concerned about how this treatment would impact me but I can say confidently that it was much easier and smoother than I thought (and had read it would be!)

Secondly, this review is for other prospective parents like us, who maybe considering infertility treatment. 

These are our key learnings from our first cycle:

•          Do Research: Please do not blindly trust your doctor. Read, research and get a second opinion! In India specially, there are no authorities to check for consistency in process and quality. A doctor with a fancy degree, quoting research and publications may seem they know everything but the medical field is constantly changing and it’s important to understand where the doctors capabilities lie and if that matches our needs. Certain doctors maybe better with female infertility and some others maybe better with male infertility issues. Success rates hide these smaller more important details so it is extremely important to do our own research. Note down and ask questions from the doctor - they should be able to answer all our queries patiently and keep us in the picture. The doctor maybe the expert in the field, but we have a right to the information since we are undergoing the process.

•          Understand the process : The doctor, embryologist and lab are all important in this process and I cannot stress enough on the importance of the embryologist. The previous doctor may have been accomplished in women’s issues but did not seem to have the confidence to deal with male factor infertility and probably did not have competent Embryologists to do an icsi procedure which requires tremendous skill. If we had not sought out a second opinion we may have been fooled into thinking that donor sperm is our best chance for a viable pregnancy which is incorrect because my husband had 5 million sperm and men with no sperm count can also father their own children.

•          Have realistic expectations: IVF has a 30-40 % chance of success based on the woman’s age so there is no guarantee of success, much like anything in life. I know there are financial considerations involved but again, do the research to evaluate how much you could afford to set aside for the treatment based on your situation (everyone’s story is different and unique). Try and be prepared for more than one cycle from the beginning - this eases the psychological pressure.

•          Communicate: In most cases, the IVF journey is one you are not in alone - communicate and celebrate this time with your partner or anyone special because it could be leading up to one of the most precious moments in your life. God forbid, even if it does not have the desirable outcome, you are stronger because of this journey. You took control and decided to make a change in your life to get something you wanted - all we can do is focus on process and hopefully we get the outcome we desire.

A note from my husband:My wife has captured our thoughts beautifully. Here are some of my thoughts on why you should consider them as your first and only choice.

1) Experience, with care: Both Dr. Aniruddha and Dr. Anjali have been doing this for decades, having handled diverse cases in this field from all over the world. This will reflect itself as soon as you have your first conversation with them. As patients undergoing the treatment, we may make this entire journey bigger in our heads and tend to worry – but what they do so beautifully is to alleviate our pain, and make the process as simple as they can (but not simpler, at the cost of any qualitative compromises).What also stood out for me was their deep involvement, respect for the patient’s time and constant positivity and warmth they provide every time you go see them. You get the wonderful, rare combination of rich, solid experience of the city’s best doctors, with the complete personalization benefits of a smaller clinic which you might not get at a bigger hospital.

2) Superior domain knowledge: I don’t need to say much on this – go visit their blog, you will see the treasure trove of articles and free education you get to acquire for free even before you visit the clinic! And once you meet Dr Malpani, be sure to check out his passion for books and learning! Personally, I really respect that – he’s very grounded despite all his significant accomplishments and is still a learning machine after all these years – its inspirational.

3) Honest pricing: IVF/ICSI is a costly affair, but what I really appreciated was that all charges were fixed, standardized, upfront and affordable (relative to competitors). No hidden costs – what you see is what you get.

We want to thank Dr Aniruddha, Dr Anjali, Dr. Sai and the entire support staff for everything they have done for us. May God bless you and your family in every endeavour of your life. We also wish you, the reader, the very best in your IVF journey and if you are considering Dr. Aniruddha and Dr. Anjali Malpani & their team, we would say both of you and your embryos are in very safe, capable and nurturing hands!

The IVF journey - a guide for patients !

Helping you to build your family through IVF !

Stress , sex and infertility

Stress does not cause infertility - it's the infertility which causes the stress. However, blaming patients by telling them that their infertility is because they are so stressed out is a great way of shifting the blame onto them , and this just makes a bad problem worse, because this guilt just adds to their stress levels. They feel even worse about themselves , and can't really do anything about it – after all, no one likes being stressed !

However, one way in which stress does cause infertility is because of its effect on sexual frequency. Stress kills sexual desire , and in today's busy world , where both women and men are busy pursuing high-flying careers, they are sometimes just too busy to have sex ! Because they are travelling all the time, they aren’t able to time baby making sex during the fertile period – something urgent always crops up at the last minute !

And when they finally do manage to synchronise their schedules , the husband suffers from erectile dysfunction , because he finds it hard to perform under pressure; or the wife gets dyspareunia because of vaginismus.

It is this infrequent sexual intercourse which results in infertility – which means the underlying reason is not medical, but social !

The good news is that it’s easy to treat, and the success rates are high !

The simplest treatment option is self-insemination. You can read more about this at http://www.drmalpani.com/knowledge-center/articles/selfinsemination

Why do IVF doctors continue prescribing treatments which are ineffective?

This is something we see all the time, and often this is labeled as “ empirical therapy “ , and is justified based on the fact that "I've tried it with my patients and it's worked."

There are two reasons why doctors get fooled.

The first is the placebo effect. Just the fact that the doctor thinks the treatment will work convinces the patient that the it will , and this becomes a self-fulfilling prophecy !

The second reason is that doctors don't like doing nothing, which is why they feel it's better to do something rather than nothing. This is what patients expect as well, which why doctors are so happy to write prescriptions , even when the usefulness of these prescriptions is still unproven.

A great example for this is all the Vitamin D supplementation which is being routinely prescribed to everyone , without any proof of benefit !

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 !

Social infertility

This is not a diagnosis which is found in medical textbooks, but the reality is that in today's day and age, where men and women live in metropolises and pursue high flying careers, they are not able to spend enough time together – and not having enough sex at the right time results in infertility.

The tragedy is that this is a socially induced medical problem – they would easily be able to have a baby if they had more frequent sex.

This is a common problem amongst people who migrate to the Middle East to earn more money. Because they are able to spend only 1-2 months every year with their wife, they end up not being able to have a baby – and by the time they put this on their priority list, precious time has been wasted.

This is also a problem which plagues migrant labourers who come from UP and Bihar to work in Mumbai, in order to eke out a living.

And this is true for many middle class couples, who spend most of their time community to and fro from work, which means they are often just  too tired to be able to have sex when they get back home.

One treatment option is self-insemination. You can read more about this at http://www.drmalpani.com/knowledge-center/articles/selfinsemination

Endometriosis , infertility, laparoscopic surgery and IVF.

Endometriosis is a very common finding in infertile women and is one of the most controversial topics. This is true for multiple reasons. For example, lots of patients with endometriosis have no symptoms at all, and this is an incidental finding either on a vaginal ultrasound scan, which picks up a chocolate cyst, or on a diagnostic laparoscopy done for checking infertility. Now, on an ultrasound scan or a laparoscopy, once the diagnosis is made, then doctors usually get itchy fingers and want to treat it. The treatment is usually doing an operative laparoscopy to remove the lesion, but whether this actually helps the patient is very controversial and the worry of causes that may actually reduce fertility because every time you remove normal ovarian tissue as well, whenever you're removing the endometriotic cyst.

Of course once the laparoscope is  already inside, most surgeons will go ahead and do the procedure anyway, but this is not always in the patient's best interest, especially for an asymptomatic patient where this is an incidental finding. Also, the treatment which is offered to the patient, to a large extent, depends on who makes the diagnosis of endometriosis 'cause if it's a gynecologist who does endoscopic surgery, then usually this is what the treatment will be offered because if you have a hammer in your hand, you look for nails. If, on the other hand, the diagnosis is made by an IVF specialist, then the patient is usually advised IVF, and that's why patient preference is so important, and the patient should decide "What's most important to me?"

Obviously, treating the endometriosis is never the endpoint. It's helping the patient to have a baby if she's infertile, which is what's important, or helping to treat her pelvic pain if that's what her major complaint is. That's why patients need to be extremely proactive and learn to make the right decision for themselves in partnership with their doctor so they don't reduce their 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 !

Patient preferences in IVF treatment

Infertility treatment is always elective, which is why  I try to offer as many treatment options as possible to patients, so they can pick and choose which the right one is for themselves .

For example, patients with unexplained infertility can choose to do either IUI or IVF. Now, when I offer the patient a choice, they get very confused , because they don't know what they should do . They want a doctor who will make the decision for them.

While I'm happy to offer guidance, I don't want to be paternalistic , and I remind them that I'm not a mind reader – I don’t know what your personal preferences are.

The truth is that every treatment has advantages and disadvantages. The advantage of IVF is that it maximizes your chance of getting pregnant quickly , and you also have peace of mind you did your best and didn’t leave any stone unturned.  Thus, if you are older, and if money is not a constraint, then it’s best to go in for IVF , so you can have a baby quickly and move on with your life.

On the other hand , IVF is more expensive, and if finances are a constraint , then it makes sense to consider IUI.  These are decisions which doctors should not be making , and that's why we need to empower patients to make the right choice for themselves.

If they have thought through the pros and cons of both the options, they can make a well informed decision, so they have peace of mind they have done their best.

Please listen to your gut and follow your heart – there are often no wrong answers, and you need to find the answer which is right for 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 !

Calculating cumulative IVF pregnancy rates

Patients find it hard to make sense of success rates after IVF treatment, and while it would be great for everyone if the pregnancy rate was 100%, the sad truth is that it’s not !

This is why patients need to think of IVF success in terms of a cumulative pregnancy rate –  what are your chances of getting pregnant after doing two or three or maybe even four treatment cycles.

This is where the binomial theorem can come in very helpful.

Let’s say your chances of getting pregnant in one cycle is 30% in a particular clinic (assuming they transfer one good quality blastocyst, and the blastocyst implantation rate is 30% in this clinic) . This means your chance of getting pregnant in three cycles is 66% . This is what cumulative conception rate means.

You need to understand the binomial theorem if you want to calculate this. The good news is that a lot of these calculators are easily available online, and if you plug these numbers in, you can determine your chance of getting pregnant after two or three or four cycles.

You can try out the one at https://stattrek.com/online-calculator/binomial.aspx

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 placebo effect in IVF

The placebo can be extremely powerful in medicine.

Unfortunately, this is a therapeutic tool which many doctors look down upon , because they're only interested in prescribing biologically active medicines which have been proven to be therapeutically effective. But the fact is that the mind has an important role to play in healing, and I'm sure this must be equally true in IVF treatment.

While there is no proven connection between stress levels and pregnancy rates, it makes sense to minimize stress levels for the patient , even though we don’t know if this will actually improve pregnancy rates.

Thus, all IVF clinics have seen patients who have got pregnant while waiting for their IVF treatment. It's possible that just the fact that they were finally going to do IVF can help them to get pregnant on their own.

And plenty of patients who have had their first baby with IVF have gone on to have their second baby without any medical assistance at all ! While it's possible that the pregnancy improve their fertility, it'a also possible that they already have a baby helped them to have their second one because they weren't as anxious as in the past.

This should be an interesting research study to do , and easy to carry out. The placebo ( “treatment”) arm would be an empathetic, kind doctor, who spends a lot of time talking to the patient , and helps them feel positive about the treatment – someone who shares information with them proactively, so they know they're in control of the situation. The control arm would be the regular doctor, who deals with patients on a “ business as usual” basis.

It would be interesting to see if the additional time which the doctor spends with the patient by injecting hope will increase pregnancy rates !

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 !

Stress and IVF

Most patients going through IVF treatment are fed up of hearing the advice that they should just relax and not get stressed out.

Everyone knows that stress is not good for you , and no one chooses to be stressed, but telling people to relax is hardly helpful. After all, how do you implement advice like that? Stress is a completely normal human psychological response – especially when you are going through an expensive  treatment like IVF, where the outcome is so uncertain.

I'm a strong believer in the fact that it's not stress which affects fertility - it's the infertility which causes stress . I’m sure if I were doing IVF, I would be as stressed out as my patients !

Giving unhelpful advice and telling infertile couples to “relax” actually just makes a bad problem even worse. It adds to the “ blaming the victim “ syndrome, the poor patient ends up feeling she's not getting pregnant because she is too stressed out.

A kinder and more balanced approach is to say, "Yes, I can completely understand why you're stressed, and here are some techniques I have used in order to manage my personal stress in my own life - such as mindfulness, yoga and meditation."

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 is test tube baby treatment so expensive?

Many infertile patients get major heartburn when they realize that they aren't able to afford test tube baby treatments because they are so expensive. They can't understand why IVF doctors charge so much, and lots of patients end up thinking of IVF clinics as being greedy.

Patients need to understand that part of test tube baby treatment is clinical – and this is what the patient sees. This includes: consultations, blood tests, ultrasound scans, egg collection, and embryo transfer.

However, the heart of the IVF treatment is the IVF laboratory, and the patient doesn’t get to see what goes on behind the scenes in the IVF laboratory . This is extremely expensive , because the consumables ( test tubes and petri dishes) , and the culture medium are all imported ( which makes them expensive); and disposable, which means we can’t reuse them.

One way of reducing these costs is to get government hospitals to offer IVF treatment , because it's hard for private doctors to be able to do it inexpensively.

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 !

Complications and risks of IVF treatment

Most woman are worried about the possible risks and complications of doing IVF treatment, but part of the problem is the many myths and misconceptions which plague IVF . Thus, it is clear that IVF doesn't increase the risk of birth defects and it won't cause breast cancer or ovarian cancer, but lots of websites continue to disseminate this misinformation.

However, as with any other treatment, there are potential complications and this is why selecting a good IVF doctor is so important. One of the possible medical  risks is that of ovarian hyper-stimulation syndrome ( OHSS), but in a well-managed clinic, this risk should be virtually zero.

This is why it's so important that patients understand the medical details about their treatment , so they can check if their doctor is doing is following best practices. Obviously , the risk of complications is much higher in a poorly run clinic which doesn’t  have enough experience or expertise to monitor each patient properly .

There are other medical risks , and a clumsy doctor could cause bleeding , or an infection , after the egg collection . There is also the risk of multiple pregnancy, especially for clinics who transfer too many embryos .

Finally, there is a potential risk for an ectopic pregnancy , which means the embryo, instead of implanting in the uterus , may implant in the tube and this is not something which any doctor can do too much about.

Being actively involved in your treatment will help you reduce the risk of complications , because you can make sure that you go to a good clinic , where the complication rate is going to be lower because they know how to provide high quality care .

In reality, the most important complications of IVF are not medical ! They are the emotional trauma which patients go through, especially when the cycle fails ; and the financial risk, which means that in spite of spending all that money , there is no surety that the patient will get 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 !

Test tube baby clinics - quantity over quality

Many IVF doctors take pride in the large number of patients they treat , and they boast about the fact that they do a huge number of cycles every month .

While this may be great for their bragging rights - and their bank balance - this is often not in the patient's best interest , because these clinics are often like assembly line factories , where everyone is treated with exactly the same rigid protocol.

There is very little personalization , and no hands on care , because the doctor is so busy doing one procedure after another , that he really doesn't have the time or the energy to focus on you.

This is extremely unfair on patients , who end up feeling cheated , especially when the cycle fails.

 To add insult to injury, the doctor comes up with all kinds of flimsy excuses and reasons as to why the cycle failed – and to make matters worse, often ends up blaming the patient’s eggs ( and/or sperm and/or uterus) for the failure. He then suggests an even more expensive alternative treatment , such as using donor eggs or donor sperm or surrogacy , so he can make even more money !

He ends up singing a completely different tune after the cycle has failed , and rather than taking responsibility for this , or trying to explain to the patient what could have gone wrong , he washes his hands off, and tries to pin the blame on to the patient .

This is why patients are so unhappy and dissatisfied with the quality of IVF treatment they get in India .

Unfortunately , this is still an unregulated industry , which means patients need to be careful about whom they select for their test tube baby treatment – let the patient beware !

If you want hands on personalized care, you need to spend time and energy on selecting the right clinic ! Just because the clinic is very crowded doesn't necessarily mean it's the right clinic for you – please use your discretion when making such an important decision !

 Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

The biggest mistake which IVF patients make in India

The biggest mistake which IVF patients make in India is blindly trusting the IVF doctor

It’s extremely important that you find a doctor you can trust – and it’s equally that you make sure that he earns that trust ! Trust is too important to be gifted to anyone .

The trust equation , as defined by David Maister, says that the doctor must prove that he is reliable and credible – and you need to check this before signing up for your treatment.

Is he willing to share information ? Is he upfront , open and transparent ? Or does he make a lot of promises because he wants to sell you on doing IVF treatment at his test tube baby clinic ? Is it a lot of hot air he is promising , or is he respectful , and makes sure that you have realistic expectations about what IVF treatment can offer you ?

Test tube baby treatment is expensive, and you have to be very careful about whom you select for as your IVF doctor.

The single question which all patients should ask their IVF doctors is – Do you do blastocyst transfers routinely ? and do you provide patients of photos of their embryos routinely ?

All good clinics do this routinely – and if you find out that the doctor doesn’t, then this is a red flag, and you should find a better clinic before burning your hard earned money !

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 limitation of testing for ovarian reserve

The chances of getting pregnant after IVF depend on the quality of the embryos, and the quality of embryos depends on the quality of the eggs. This is why testing for ovarian function is extremely important before doing an IVF cycle. We know that patients who have better ovarian function have a higher chance of getting pregnant, which is why measuring antral follicle count, as well as the AMH level, is so important.

However, we need to understand the limitations of these tests. Thus, there are patients with low AMH levels who do get pregnant after IVF – and there are patients with normal AMH level who has a poor ovarian response.

While the quantity and quality of eggs usually go hand in hand, this correlation often breaks down.

This is because the quality of the embryo is determined by the energy which the mitochondria in the cytoplasm of the egg can provide, and this is not something we can measure based  on either an AMH level or an antral follicle count.

Sadly, there is no test as yet which allows us to assess the mitochondrial competence of the egg, and this is why an IVF cycle gives us information as regards egg quality which nothing else can as yet. How good the quality of the embryos is tells us far more about the quality of the eggs as compared to any other test !

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 problem with ovarian functions tests

The chances of getting pregnant after IVF depend to a large extent on the quality of the woman's eggs, and this is why older women have lower pregnancy rates.

 This is why testing for ovarian reserve is so important, and we measure the AMH level as well as the antral follicle count , so we have some sense of how well the patient is going to respond to superovulation, and what her chances of getting good quality embryos is going to be.

The trouble is that these numbers only provide an estimate of static ovarian reserve – they are not dynamic functional tests. What we really want to know is how the patient will respond to the superovulation and we can only find this after actually doing the IVF cycle.

This is why an IVF cycle is not just a treatment procedure – it also provides invaluable diagnostic, as well as prognostic information.

Based on how you respond to the cycle, we are better positioned to know what to do differently in the next cycle. For example, do we change the protocol ? or do we consider using donor eggs? The only way to answer this key question is by actually doing the IVF cycle – there are no shortcuts !

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 !

Test tube baby clinics – judging the quality of the clinic

Because patients are not sophisticated enough to be able to judge the technical competence of an IVF doctor , most of them use other alternatives to decide which doctor to select the best.

This is why a lot of them will go to the busiest doctor , based on the assumption that if the doctor is busy , he must be good ! This is based on the concept of social proof , which is why a lot of follow a herd mentality when making a decision .

The danger is that these clinics are so busy that they are completely impersonal, unless you happen to be a VIP or a celebrity. The doctor doesn't have enough time or energy to spend on you , as a result of which the care you get is not tailored to your needs. The clinic follows a rigid protocol . because they function as an assembly line, which is designed to do an many cycles as possible every month.

This is why patients can't afford to leave everything up to the IVF doctor - especially in India , where there is no government regulation , and the success rates among clinics vary widely .

Sadly, doctors are not very honest about what their clinic’s success rates are, which is why everyone merrily claims a 70 percent success rate - even though this has no bearing with reality ! Because there is no one to check or verify these tall claims , they continue to get away with it , and this is why patients get taken for a ride .

Ironically , even though patients in India aren't really well equipped to be able to differentiate between good doctors and bad doctors , the burden of doing so actually falls disproportionately on their shoulders , because the government has failed in its duty to do this for them !

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Why do patients do such a bad job of selecting IVF clinics

We all know that all IVF clinics are not created equal , and their success rates can be dramatically different !

And some can be much more expensive than others !

So how is the poor patient to decide who the right IVF doctor is ?

Sadly, a lot of patients naively assume that all doctors provide the same high quality of care , and this is where they make a huge mistake , because they end up wasting a lot of time and money doing their treatments in low cost clinics, just because they are cheap and convenient!

Typically, the doctors in these clinics talk very sweetly , because they want to sign up as many patients as possible. Their focus is on quantity rather than quality , and most of these clinics are like impersonal assembly line factories, which process patients mindlessly, and take pride in how many treatment cycles they perform every month – rather than on how well they take care of their patients !

This can be an extremely expensive mistake , because the pregnancy rates in these clinics is usually very low , which means patients end up wasting all their money and depriving themselves of a chance of having a baby .

This is why it's important that patients need to do their homework so they can be sure the clinic they select is technically competent .

If you end up in the wrong hands, this can be an expensive error , which you may not be able to recover from , and you will end up ruining your chances of you 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 !