Wednesday, August 29, 2018

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!

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