What patients need to know about IVF Treatment Protocols

One of the common questions patients ask us is – What treatment protocol are you going to use for our IVF cycle ?

There are lots of super ovulation protocols available , and many clinics are very rigid and will use only one protocol for all their patients. They follow a mindless regime, because most of the treatment is done by assistants, who don’t have the experience or the expertise to be able to tailor it for the needs of the individual patient.

Thus, some will routinely use a long downregulation protocol , which uses about 8 days of injections before the period starts, for down regulation before beginning the IVF cycle. Other use a short protocol, which starts from Day 1 of the cycle; while other use a some will use a GnRH antagonist protocol.

We take pride in the fact that we will tailor the protocol according to what the patient's requirements are. We are not rigid, because the treatment is crafted personally us, and not by assistants  - we don’t have any assistants ! This is why it’s not a mindless checklist protocol , where one size is forced to fit all patients, and everyone is treated the same, no matter what their ovarian reserve is.

We customize the protocol depending on the patient's history. The key variables we use are her ovarian reserve ( as judged by her AMH level ( https://www.drmalpani.com/knowledge-center/articles/treating-women-with-a-low-amh-level)  and antral follicle count ( https://www.drmalpani.com/knowledge-center/articles/afc) ; and her ovarian response to earlier IVF cycles. We can tweak our protocol to improve their egg quality, and this is why our success rates are so high.

Want to find out which is the best treatment protocol for 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 !

The harm done by treating IVF patients in batches

Lots of IVF clinics  - especially the IVF chains - will batch patients together. Some do this because they don't have a full-time embryologist , or an expert -time IVF specialist , and they have to depend on someone to come from outside the city in order to do the actual treatments. Others do this because they have lots of centers all over the city, and their doctors travel from one clinic to another in order to treat as many patients as possible.

Now, this might be convenient for the doctor, and helps to maximize their income, but is obviously not very good for the patients. They have to wait, and this wastes a lot of valuable time. This can be a big issue, especially for patients who are travelling from other cities to take treatment.

More importantly, this often affects their IVF success rates. The doctor then either has to put them on injections for a long time, or manipulate their cycle using birth control pills, none of which is in the patients' best interests !

This kind of cookie-cutter approach, where the individual needs of the patient are not respected reduces IVF success rates.

Because we are a full-service IVF clinic , and have full-time staff, we can treat the patient according to their own natural cycle, which means we have a lot more flexibility when treating them. This is very convenient, specially for patients who are coming from out of Mumbai for treatment, because we can start treatment whenever they come, rather than have to wait for a batch to start.

Also, we can tailor our protocols according to their natural cycle, which is why our success rates are so high.

Want an IVF  treatment protocol tailored to your body ?  Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

IVF independent pregnancies

We all know what IVF pregnancies are – these are the pregnancies which are a result of an IVF treatment cycle !

IVF independent pregnancies are common as well . These are the patients who are waiting to do IVF treatment , and who get pregnant even before they actually do the IVF !

 This might seem unusual. After all , if the doctor decided they needed IVF and yet they got pregnant without doing it, doesn't that suggest that the doctor was advising unnecessary treatment?  

Actually this is not always true. We know that couples with unexplained infertility ( where everything is normal on their tests , and no medical problem is diagnosed) will pregnant on their own, for unexplained reasons !

This could be partly because they're looking forward to the fact that they are finally taking IVF treatment for helping them to have a baby , and this may help to reduce their anxiety levels; or the tests during the IVF workup may help to improve their fertility.

Just like we've seen that sometimes some infertile couples get pregnant on their own after adoption , we’ve seen couples get pregnant even before starting their IVF cycle. Some couples who needed IVF to get pregnant with their first baby often find to their delight that they are able to achieve a second pregnancy all by themselves – and this could be because pregnancy may improve their fertility , for reasons we still don’t understand well !

Think of these as a "bonus" - after all, a baby is a baby !

Want to learn more about IVF ?

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf

Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Is IVF safe ?

A lot of people are very worried whether IVF is safe or not, and many infertile couples are not allowed to do IVF by their family members, because they are concerned about the side effects of IVF - both on the mother , and the baby. After all, they believe that in an IVF cycle we're pumping the mother full of powerful hormonal injections – surely these are going to have some adverse effects on the body.

Thus, many people believe that these hormones increase the risk of breast cancer and ovarian cancer ; or that an IVF patient will run out of eggs faster and become menopausal sooner, because the IVF cycle “ uses “ up her eggs.

They are also concerned that IVF babies are “ weak  and abnormal”. After all, with IVF , you're fiddling around with the eggs and sperm and embryo in the laboratory , and doing something artificial which is certain to have consequences .

However, the reality is that IVF is extremely safe and effective. Millions of babies have been born after IVF over the last 30 years, and there is no increased risk of birth defects whatsoever . After all,  IVF only allows us to do in the lab what’s not happening naturally in the bedroom. It’s not artificial reproductive technology –it’s assisted reproductive technology, where we are giving nature a helping hand !

Similarly, the hormones used for superovulation are natural hormones , which are excreted properly from the body after the IVF cycle, so you don't need to worry about any long term adverse effects.

Yes, some women will put on weight after IVF – but this is not a result of the IVF treatment ! Weight gain occurs when caloric intake is more than caloric expenditure, and because women often take bed-rest during their IVF treatment, they do tend to put on weight, but this is not a side-effect of the hormones ! Once they start their normal routine, they go back to their normal weight very quickly !

You can learn more about IVF by downloading the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf

Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

What does IVF downregulation mean ?

I love answering patient's questions about IVF , because I think the more they understand about what we are doing, the better they'll be able to appreciate the difference between a good IVF clinic and a bad IVF clinic.

Someone asked me – what does down-regulation mean, and why do we need to do this ?

When growing egg during an IVF cycle, we use 2 processes - one is super ovulation, while the other is downregulation. Think of these as the 2 levers which allow us to precisely control your egg production.

Super ovulation , as the name suggests, uses hormones to help you to grow lots of eggs. These are natural hormones, and since we give them in a higher dose, they help to prevent your follicles from dying, so that you grow many follicles in the IVF cycle.

Down-regulation means we also need to give you another set of hormones , to prevent these follicles from rupturing on their own once they become mature .

While we stimulate your ovaries to grow lots of follicles ( which contain the eggs) , we also need to switch off your pituitary at the same time, so that these follicles don't rupture on their own.

Down-regulation can either be done by using GnRH agonists, using what is called a long protocol or a short protocol; or by using GnRH antagonists. Both these methods are equally effective, and the advantage of the GnRH antagonists is that you need to take them for fewer days.

These injections are given subcutaneously ( under the skin), and are easy to self-administer.

You can learn how to take your injections at http://www.drmalpani.com/knowledge-center/articles/injections

Want to learn more about IVF ? You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf

You can also send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Making sense of your symptoms during an IVF cycle

Lot of patients get all kinds of symptoms during an IVF cycle.

Often this is during the cycle itself – for example, they may feel bloated; or have breast pain; or feel very irritable. And many of these symptoms become much worse during the 2 week wait, when the mind plays all kinds of games.  Everytime you get a backache, you are petrified that your cycle has failed and that your period is going to start.

It’s very hard to provide a biological explanation for these complaints. The reality is we often don't have a very good answer for a lot of these aches and pains.

Each woman experiences them differently and there is often no underlying common denominator.

However , we're not too worried or concerned about them, because we know they are common and are not medically sinister – they don’t suggest there's a complication , or anything's amiss.

All we can do is tell patients this is one those things they are going to need to learn to live with. Now, this doesn't mean that we're unsympathetic or we don't care – it’s just that we know that these symptoms are temporary and will pass.

We tell patients to take try home-remedies and take symptomatic relief to tide over this trying time, and not to worry about them.

I know this is easier said than done, but worrying needlessly doesn’t help at all, so it’s best to distract yourself and carry on with life !

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

What makes Malpani Infertility Clinic so special !

What are your options after a failed IVF cycle ?

When an IVF cycle fails, patients want an answer to the most important question which is – What next? What are my options?

Now just because an IVF cycle has failed doesn't mean that you're never going to be able to have a baby, so please don’t start catastrophising or obsessing that all is lost.

This is why getting counseling before starting your IVF cycles , and doing your homework is so important, because this way you have realistic expectations of the IVF treatment, and you understand that often it takes time in order to achieve a pregnancy after IVF.

The first cycle failing is not the end of the world – it’s just the beginning of your journey to success !

The important thing is to analyze the cycle, so you can learn from it, and determine what went well, and what didn’t .

This is why sitting down and review your medical records your doctor is so important. The key here is the answer to a single question – What was the quality of your embryos?

It can be very helpful to get a second opinion , by sharing photographs of your embryos , as well as your IVF treatment protocol , with another IVF specialist , so that he can provide an alternative perspective.

He may be able to notice what the first doctor missed , so he can tell you what he can do better in order to increase your chances if you do another cycle.

Could 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 better?

Why frozen embryo transfers are better than fresh IVF cycles.

In the past, it was believed that the chances of getting pregnant were better when we transferred fresh embryos in an IVF cycle. 

After all, the word " fresh " itself suggests that these are vital , viable embryos, which are much more likely to implant, as compared to frozen embryos.

Patients would confuse the quality of frozen embryos with the quality of frozen vegetables and fruits kept in the refrigerator. This is why they would believe that these were stale, or not as healthy as fresh embryos.

In fact, this was true in the past, when we used slow freezing in order to cryopreserve embryos.

The technology for freezing embryos wasn't very good, as a result of which a lot of these embryos would die as a result of freezing and thawing them. 

However, the technology has improved dramatically, and we now use vitrification to freeze embryos. In our clinic, the survival rates are 100% , which means the pregnancy rates are better when we transfer frozen embryos,

This is true for many reasons.

1.  The endometrial receptivity is much better in a frozen cycle, because we can prepare the uterine lining optimally . In a fresh IVF cycle, the high dose of hormones used for superovulation can impair endometrial receptivity.

2. We can transfer only a single embryo at a time, so that the cumulative pregnancy rate remains high; and the obstetric risks of a multiple  pregnancy go down. This improves the live birth rate

3. It gives you more flexibility, and increases your options, because you can store your embryos, and use them for your second and third baby as well after a few years

4. The frozen thaw transfer cycle is much easier and less stressful, because there are no injections, and you just need to come to the clinic for 2 -3 scans !

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

Questions patients ask after a failed IVF cycle

IVF failure can be devastating  ! You invested all your hopes and money in this treatment which offered you the best chance of getting pregnant, and when it fails , this means that you're back to square one !

Patients have lots of questions after a failed IVF cycle.

How soon after a failed IVF can I try again?

What are my chances of conception after a failed IVF?

Is it possible for me to have a natural pregnancy after a failed IVF?

Why did my IVF cycle fail?

And all of these are perfectly reasonable questions, and step number one is to review your medical records with your doctor ,  to find out exactly what didn't go right – and what went well.

And if you don't have your medical records – especially photos of your embryos - this itself is a red flag, which means you need to get a second opinion to be able to determine what you can do in order to improve your chances in your next cycle.

There's no reason to go to pieces or to give up , just because one IVF cycle fails. The important thing is to learn from it , and then do what you can to improve your chances of success for your next cycle !

 You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf

and this will help you make better decisions !

Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Free comic book for infertile couples

You can check this out at https://www.drmalpani.com/flippingbook/

What is the difference between an infertility specialist and an IVF specialist?

Lots of patients get confused about whom to go to when they want to baby, and most of them will go to the local gynecologist. This is especially true if they have had secondary infertility, and have already had a baby, and they assume the gynecologist will be handle to their infertility issues as well. After all, he delivered them the first time, didn't he?

                                And aren't gynecologists supposed to be specialists taking of women's health? Or they will go to a gynecologist for a regular check-up and will assume that he will be able to provide treatment, because these days every gynecologist calls himself an infertility specialist as well.

                                But the reality is, there is a big different between an IVF specialist and an infertility specialist. And a lot of so-called infertility specialists don't have the training, or the expertise, or the laboratory backup to be able to actually provide specialized care for infertile couples, which means these couples waste a lot of time and money.

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf to help you make better decisions !

Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

What infertile couples need to do to make the right decisions

                             One of the hardest things infertile couples need to do is to make decisions. This is especially true when they are thinking about emotionally charged and sensitive issues as to whether to use donor eggs or not. After all , there are always multiple options, and the answers are never black or white. This can become  especially difficult if both husband and wife don't see eye-to-eye about the subject.

                                There really is no easy answer for this kind of impasse, and doctors are not always the best people to give guidance, because this is something that depends on your individual personal preferences.

                                It can be very helpful if both of you can talk to one person whom you both respect and trust. This could be one of your parents - or perhaps a coach ; a friend; a mentor; or a psychological counselor , who can help you discover the right decision for yourself. You need to find someone who is kind and empathetic, so you can unburden your heart,  and discuss the pros and cons of all the options which are available to you.

This path will give you peace of mind that you've made the decision which was right for you !

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf to help you make better decisions !

Or you can 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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What are my chances of getting pregnant with IVF ?

Most IVF patients want their doctor to give them a number in answer to this question , and they naively believe that the higher the number , the better the doctor !

The problem is that this number is quite meaningless . For one thing, it is usually an estimate – and before starting the cycle, it's not a high quality estimate, because doctors are forced to lump all their patients together in groups, according to their age.

The problem is that doctor  aren't fortune tellers, and we cannot predict how many eggs you will actually grow, or what the quality of your embryos will be, which is why this is a very  imprecise number. What’s worse is that lots of doctors will inflate the number, because they are trying to hook you into doing an IVF cycle with them, which means you can't even trust that number in the first place.

The reality is for an individual patient, any number - whether it's 20% or 40%, or 60% - is a meaningless number. For you,  either you get pregnant, which means it's a 100% success rate; or you don't get pregnant, which means it's a 0% success rate – there’s nothing in between !

A far better question you should be asking yourself is "If I do nothing, what are my chance of getting pregnant on my own ? How much does IVF increase those chances by? What's the delta?"

This way you have peace of mind that you've made a well thought-out decision for yourself.

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf and this will help you make better decisions !

Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

The limitations of embryo grading in the IVF lab

Embryo implantation is an extremely complex process, and sometimes patients get frustrated when good quality blastocysts do not implant. But you need to understand that even if two blastocysts look exactly the same, their implantation potential can be very different.

                                Thus, for example, if we have two blastocysts , both of which have the same grade - let's say 3AA - but one came from an older woman with a poor AMH level whereas the other one came from a younger woman with good ovarian reserve, the  chances of the blastocyst which came from the younger woman implanting are much higher, even though both the embryos looks exactly the same.

This is one of the limitations of a embryo grading system - that it just captures how the embryo looks at a particular moment of time. It doesn’t tell us anything about the quality of egg this embryo came from, even though we know that egg quality plays a big role in embryo implantation, because it affects the genetic competence of the embryo.

After all, no one cares about how beautiful the blastocyst looks like on the day of the transfer – we are much more interested in its future potential of being able to grow in the uterus and implant – and we still can’t predict this accurately as yet.

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf and this will help you make better decisions !

 Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

The donor egg decision

Over the last 30 years, we have treated lots of patients who have used donor eggs to have a baby. The vast majority of these patients are extremely happy with their decision, and many have come back for a second baby, in order to complete their family.

This is especially true when they have chosen that decision for themselves, for purely selfish reasons. They decided , "Yes, this is what we're happy to do, because I want to experience the joy of pregnancy and the happiness of bringing up a baby, and I'm not hung up about whose DNA it is."

                                On the other hand, there are lots of infertile couples who accept the option of donor eggs very reluctantly. Their justification is, "Well, what else can I do? This is the only option available. It's better than adoption, so I'm willing to compromise. I don't want to keep my husband unhappy," or, "My mother in law is forcing me to do it."

I don't think it's a good idea to use donor eggs if you think of it as being your second best option, or if it's one you're not comfortable with, and is being forced down your throat because of family pressures.

If you do that, you're not going to be happy, and you're not going to be able to bring up your child happily either.

You are the most important decision maker – and you need to make a decision you are at peace with !

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf and this will help you make better decisions !

Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

What are my chances of IVF success

Every patient wants to know what their chances of getting pregnant with IVF are going to be, because they need to know how much time, money and energy they are going to have to invest in pursuit of a baby.

Now the reality is that  it's not possible for us to give a very accurate answer before starting the cycle. We know that young patients have a better chance, and older patients have a lesser chance, but this is just an overall generalization, which applies to groups of patients – not to individuals.

And you are an individual and don't really care about what's happening to the other patients in my clinic - you only want to know what's going happen to you !

Please remember that our ability to give you an accurate number increases a lot more after we've done an IVF cycle, because we then have a much better idea of what your ovarian response is; how good your embryo quality is; and how your endometrium grows.

This means you need to be patient if you want a truthful answer. If you pressurize the doctor into giving you a number, we will trot a generic figure out, but it is going to  be extremely imprecise and inaccurate, and may confuse you.

So sometimes you need to ask yourself, "Why am I asking the doctor this question? Will the answer change my decision, whether it is 30% or 40% ? " And if it will not, then please go ahead and do your IVF with a smile !

But won’t the number help you to compare clinics, and decide which one to choose ?  I wish this was true, but in India it’s not, because every clinic claims a success rate of over 60% per cycle – even if their real success rate is 10% ! Sadly, there is no way for patients to verify these claims, which is a tragedy !

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf and this will help you make better decisions !

 Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Infertility and irregular periods

Many infertile women have irregular cycles , and they know that this is the reason for their infertility, which is why they go to the gynecologist for treatment.

They doctor is happy to prescribe hormonal medicine to help their periods to become regular, but what they fail to realize is that just getting regular periods is not enough to help them to have a baby. They need to be very clear and focus on what their goal is.

If they just want regular periods, then taking hormonal tablets such as birth control pills is fine, but this is often just a distraction , and ends up just patching up the problem, and wasting time.

You need to understand that the irregular periods don’t cause infertility directly - the irregular periods are just a symptom of the underlying disease.

The reason for both the irregular periods and the infertility is anovulation - or not producing eggs. Now, giving birth control pills for forcing a menstrual bleed; or  inducing periods with tablets such as medroxyprogesterone acetate will help them to get regular periods as long as they take these medicines, but will not help them to treat the underlying condition, which means they will not ovulate or produce eggs. The problem will recur when they stop the medicines, which means they will be back to square one !

This is why they need to focus on inducing ovulation if they want to have a baby, and this is why patients need to be very clear and upfront with their doctor as to what their priorities are.

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf

and this will help you make better decisions !

Or you can 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 doctor’s bedside manner

Most doctors are great at talking sweetly to patients at the time of the first consultation, because they want to lure the patient in for treatment.  It’s easy to give patients lots of hopes and promises, and many patients like this , because it boosts their confidence , and they like the doctor’s positivity. They feel that being treated by a confident and optimistic doctor will improve their chance of getting pregnant.

But this has a downside and can backfire , because when the cycle fails , the patient feels completely let down. The same highly positive doctor becomes negative, and starts to ignore the patient; or refuses to answer calls; or blames the patient for the failure.

On the other hand, many IVF doctors are very scientific and rational. However, if you are cut-and-dried and stick to statistics , patients feel that you're not empathetic and are not able to connect emotionally with them, because you don’t understand their feelings.

They resent the fact that you're not being encouraging , or providing them with the confidence boost which they need to go ahead with the IVF cycle !

It's always a tricky balance, and both doctor and patients need to find a partner they are comfortable working with !

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf

and this will help you make better decisions !

Or you can send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !