When IVF doctors do not have all the answers

One of the problems with IVF is that we often don't have answers to our patient's questions.

This is particularly true when an IVF cycle fails, even though the embryo was top quality ; the endometrium was perfect ; and the transfer went smoothly. Now patients demand answers , and doctors are under a lot of pressure to provide these !

The commonest question is - Why did it fail ? and What can we do differently the next time?

The knee jerk response is to order lots of additional tests , and use these to start offering additional options, such as using donor embryos or surrogacy or donor eggs, none of which makes any sense to me if the cycle went well. .

If the cycle was medically perfect, then it's just a question of being patient , and repeating the cycle until it works .

What about all the extra expensive tests which doctors doctor after the IVF failure, such as ERA testing ?

If these tests were really helpful, then ideally these should have been done before the cycle was   started ! Why wait for the cycle to fail before running these tests?

Sometimes patients need to understand that IVF has its own limitations , and we don’t have all the answers. Doing more tests will just add to the confusion, and not provide any additional useful actionable information !

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 !

Older patients and IVF

The four factors which affect embryo implantation

After the embryo transfer , every patient wants to know -  Will I get pregnant or not ?

There are 4 factors which we need to consider. 

The first is the quality of embryo . What was the grade of the blastocyst which was transferred ? A photo is worth a 1000 words, and you can check the quality by comparing it with pictures of embryos which you can find in online atlases.

The second is endometrial receptivity, as measured by its thickness and texture , which is checked on the  vaginal ultrasound scan .

The third is the ease of the embryo transfer , which is usually done under ultrasound guidance , so you can see how easily the catheter entered the uterus.

These are the 3 tangible factors which influence embryo implantation – the 3 Es –

Embryo quality;   

Endometrial receptivity; and the 

Embryo transfer technique. 

However , there is also an additional  fourth factor , which is also extremely important - and that is luck. 

Now this may not sound very scientific , but because implantation is a biological process , there are lots of things about it which we don't understand and  cannot control .

This is why luck continues to play an extremely important role in IVF , and it's one of the things both doctors and patients need to come to terms with !

Best of luck – we  hope and pray that your embryo becomes a baby !

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 !

Why do infertile couples waste money on repeated IUI cycles ?

The importance of your medical records of your IVF treatment

I see many patients who have done an IVF cycle in other clinics , but have failed.

I ask them for a copy of their medical records, as well as photos of their embryos, so I can analyse what we can do to improve their chances of success for their next cycle.

The standard response is, " The clinic did not give us any records – they keep these themselves”.

Some of them go back to their doctor and ask for photos of embryos, and the standard response is - "Sorry, we don't provide embryo photos to our patients, because it's not part of our medical protocol."

This is complete rubbish, and just means the doctors is giving the patient a brush-off.

Medical care all over the world is the same, and all good clinics standard good practices. After all, doctors cannot pick and choose what they want to do, and what they don’t !

As a patient, you have paid for your medical treatment, and you need to be assertive. You need to demand copies of your medical treatment records, as well as photos of your embryos.

However, the best time to do this is before you start your treatment cycle, because after you've paid your fees, the doctor will give you all kinds of flimsy reasons for not sharing the medical details with you, and there will be nothing you will be able to do about this !

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

Infertile couples are not patients !

Infertile couples should stop thinking of themselves as being patients. 

The reality is that they're really not sick. For one thing, not having a baby is the same as being childless , and this is a description of a social condition , rather than a medical label !

Thus, there are some fertile couples who don't want to have a baby . 

They are child-free , and are not infertile !

Yes, infertility is a medically treatable problem , because it is a result of a medical disease ( for example, a low sperm count or blocked tubes). However, this doesn't mean that the woman, who's taking IVF treatment is a patient. She's not sick, and just happens to be going to a doctor for help with having a baby.

Please remember that all we're doing with a lot of our assisted reproductive technology ( ART) is helping nature and giving it some assistance , so that we can do in the lab what is not happening naturally in the bedroom. 

After all , ART is assisted reproductive technology - not artificial reproductive technology. 

We're not doing anything artificial or creating synthetic eggs or sperms or embryos in the lab ! This is why infertile couples should treat themselves as being normal people who just need some assistance to get the baby making process kick-started !

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 !

Should I transfer one embryo or two?

It's very tempting for an IVF doctor to make decisions for a patient. After all, we are the medical experts and patients expect us to make the decisions for them,  because we're the ones who are supposed to know what to do.

They trust that we will give them the right advice, and we are happy to do so, but doctors are not dictators, and we need to respect our patients' preferences.

When there is an option, what we try to do is help the patient to make a well-informed decision for herself, so that she has peace of mind she has made the right decision.

We'll explain the pros and cons of both the choices, and explain the medical facts to her, but at some point, she needs to provide her own inputs ! After all, doctors are not mind readers, and she needs to make a decision she's comfortable with.

Part of the problem is that if the patient gets pregnant, the patient labels the IVF doctor as being good. However, if the cycle fails, then she labels the doctor as being a bad doctor.

This is completely flawed reasoning, which is why we try to be transparent and open with the patient,  and involve them in the decision making process.

Yes, this takes more time , and it causes more anxiety for the patient, but this is the best approach for her. We promise her that we will provide a safety net – that we will never let her make a wrong decision – but when there are choices, it’s best that she decide for herself.

Thus, we always suggest that patients transfer only a single blastocyst at a time – but if the patient wants us to transfer 2, we will accept her wishes.

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 !

नाकामियाब आई.वि.ऍफ़ उपचार| क्या करे?

नाकामियाब आई.वि.ऍफ़ उपचार| क्या करे?: जब आपका आई.वि.ऍफ़ उपचार काफी बार दोहराने के बाद भी नाकामियाब होता है, तब ये डॉक्टर और मरीज दम्पत्योंके के लिए काफी निराशा जनक होता ...

Which is the best IVF clinic in India ?

Many patients ask me to refer them to IVF clinics in their own city, because they find taking treatment locally is much more convenient.

The problem is that it's hard to be sure about the quality control standards which clinics adopt, which is why I am reluctant to take any names when guiding patients. If they have a bad experience, I don't want them to blame me.

This is why my advice is simple - 

Please look for a clinic which does only blastocyst transfers;  and provides photos of embryos routinely to all their patients !

IVF treatment is too important to leave everything upto the doctor, and that's why patients need to be well-informed, so they can ask the right questions, and get the best possible treatment !

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 !

x

Was your IVF cycle canceled?

Most patients look forward to their IVF treatment , because they know it maximizes their chance of getting pregnant. However, when their doctor cancels  their cycle halfway, they're quite disappointed and disheartened, and are not sure what to do next.

If you're confused, please reach out to us , because we specialize in treating patients who have failed IVF cycles elsewhere, as well as those whose cycles were canceled in other clinic.

Step 1 is to drill down and find out why the cycle was canceled.

Was the problem during the superovulation ? Was it because the doctor couldn't grow eggs properly ? Or that there were too many eggs?  

Or was the problem in the lab, with failed fertilization or poor quality embryos ?

Step 2 is to get a second opinion.

Once we have all of the medical details, we can then fine tune your superovulation protocol in such a way that we can go ahead with your treatments.

Thus, if your problem was a poor ovarian response, we can put you on supplements and change your superovulation protocol , to help you to grow more eggs.

If the problem was that you grew too many eggs because you have PCOD ( polycystic ovarian disease), then we can offer a gentler  superovulation protocol which reduces the risk of OHSS to zero.

If your cycle was cancelled, please don’t get disheartened and reach out to us ! Sometimes repeating your IVF cycle in a clinic with greater expertise and experience can make a world of a difference !

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

क्या डोनर एग आई.वि.एफ ट्रीटमेन्ट आपके लिए सही विकल्प है?: क्या डोनर एग आई.वि.एफ ट्रीटमेन्ट आपके लिए सही विकल...

क्या डोनर एग आई.वि.एफ ट्रीटमेन्ट आपके लिए सही विकल्प है?: क्या डोनर एग आई.वि.एफ ट्रीटमेन्ट आपके लिए सही विकल...: अपने आई . वि . एफ ट्रीटमेन्ट में डोनर एग्स का उपयोग करने के बारे में पेशेंट्स की राय काफी भींन हो सकती है | अधेड़ उम्र की महिलाये...

Do you really need IVF treatment ?

One of the concerns which a lot of infertile couples have is that lots of IVF doctors overtreat the infertile couples . It seems that if you have a hammer, then everything you see looks like a nail, which is why it appears that IVF doctors will advise IVF for every infertile couple who comes to them .

This is true, whether they actually need IVF or not .

Even when there are simpler and less expensive treatment options available, such as IUI, they use a one size fits all policy, and advice IVF for all their patients.

This is a valid concern, especially when you go to a profit-making corporate chain of IVF clinics , whose major goal is to try to maximize their revenue , because that is what their investors demand, and this is how their doctors are incentivized.

This is why it's so important to do your homework and go to a doctor who is a true professional, and  who will do what is in your best interests , rather than based on maximizing his profits.

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 cycle cancellation scam

Corporate chains of IVF clinics seem to have come up with all kinds of creative ways of extracting money from their patients .

One the commonest scams I've seen these days is to charge a hefty cycle cancellation fee.

Thus, all patients are advised to do IVF, even when the doctor knows they are not likely to grow any eggs, because they have very poor ovarian reserve.

The IVF treatment cycle is started , and the patient is asked to pay the full fee in advance as a deposit. However, when patient doesn’t grow any follicles , the cycle is cancelled, and the doctor charges a fat fee.

Inspite of knowing  that the patient is not a good candidate for IVF, the doctor still goes ahead and starts the cycle . What’s worse is that they deliberately use a low dose of injections to try to reduce the ovarian response even further, because they make money on canceling the cycle. Sometimes this is as much as 80% of the total fees, even though the clinic has not incurred any lab expenses at all.

In our clinic , our IVF cycle cancellation fees are zero , because we understand the heartbreak having to cancel a cycle causes, and we don't want to add to the patient’s misery by levying a financial cost on top of this.

 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 !

Repeated IVF failure

Repeated IVF failure can be very frustrating for both doctors and patients.

After a failed IVF cycle, you find yourself at a crossroad , because you're not sure what do next.

Should you change your doctor ? change your treatment ? get a second opinion ?

The first step is to analyze the IVF cycle carefully, and if everything went well , then you just need to be patient and repeat the cycle again , until it works.

When we say, "everything went well," this means you need to objectively check the quality of the embryos , by examining the photos of your blastocysts; the endometrial thickness and texture; and whether the  transfer was technically easy. If all these were fine, this means there's no need to make any changes at all.

Sometimes patients want to change something – anything ! – out of desperation. They believe that if everything's fine but the cycle didn't work, then we need to explore alternative options, such as doing surrogacy, or using donor eggs or donor embryos.

However, this is not logical at all !

Sometimes all you need to do is get over your heartbreak, give yourself time to recover, and then start another cycle again.

Just because your cycle has failed two or three times doesn't mean that it will keep on failing !

It’s important that you don’t start getting desperate and doing treatment which is needlessly expensive and makes no rational sense at all !

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 !

How can you be sure that your IVF doctor is telling you the truth?

This is always a big problem for most IVF patients. How can you trust your IVF doctor?

How do you know whether what he's telling you is in his best interests , or in your best interests?

Is he telling you to do IVF because that is actually your best treatment option, or is it that his advice is based on the fact that that's the most profitable treatment option for him to offer?

This is always a million dollar question, and there are lots of doubts in IVF patients' minds. It's hard to be sure whether the advice you're getting is high quality or not.

This is why doctors need to be open and transparent, and share as much information as possible, so that patients know in advance what the standard operating procedures and treatment protocols are.

This is why evidence based guidelines, which tell IVF doctors what they should be doing and when, are so helpful.  Patients can analyze these , and make sure that the advice which their doctor is giving them is correct.

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

and this will help you verify that your IVF doctor's advice is correct.

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 !

x

The fertility dilemma of the 35 year old professional woman

A lot of highly successful, well-established professional women , many of whom are on the fast track to becoming CEOs and are progressing well in their career , will sometimes find that, at the age of 35 or 36, their biological clock goes off, and they have this irresistible craving to have a baby.  They realize that their opportunity to have their own biological baby is rapidly shrinking, and that time is now at a premium for them.

It's an internal biological urge, which they've been able to successfully repress for very long, but once the alarm clock goes off, then hitting the snooze button simply doesn't work.

Their alarm just goes off again and again , and they eventually have to wake up and answer this biological desire . This is hard wired into our genes , to ensure that our species propagates itself, and it can be impossible to resist.

Many of these women just can't understand what's happening to them, because this is so different from their own perception of themselves .  They never felt they would ever have any maternal urges, and they are now forced to reassess their own self image.

The reality is that they become a very different person once this alarm clock has gone off.

The problem is that we can't predict when it will ring, but when it does, things change dramatically, and there’s little the head can do when the selfish gene’s desire to propagate itself is so strong.

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 cycle cancellation scam

Corporate chains of IVF clinics seem to have come up with all kinds of creative ways of extracting money from their patients .

One the commonest scams I've seen these days is to charge a hefty cycle cancellation fee.

Thus, all patients are advised to do IVF, even when the doctor knows they are not likely to grow any eggs, because they have very poor ovarian reserve.

The IVF treatment cycle is started , and the patient is asked to pay the full fee in advance as a deposit. However, when patient doesn’t grow any follicles , the cycle is cancelled, and the doctor charges a fat fee.

Inspite of knowing  that the patient is not a good candidate for IVF, the doctor still goes ahead and starts the cycle . What’s worse is that they deliberately use a low dose of injections to try to reduce the ovarian response even further, because they make money on canceling the cycle. Sometimes this is as much as 80% of the total fees, even though the clinic has not incurred any lab expenses at all.

In our clinic , our IVF cycle cancellation fees are zero , because we understand the heartbreak having to cancel a cycle causes, and we don't want to add to the patient’s misery by levying a financial cost on top of this.

The heartbreak of an infertile patient

I am still not able to cope up with negative pregnancy test. I just wished that the test still comes positive. My good looking embryos do not like to settle in my good looking endometrium lining. I wish that I could know what these beautiful embryos wants more from me? Why all these medicines,efforts, patience, care, precautions and prayers for having a baby is not paying off. What else can we do to fulfill our dream to have a baby ?

Crying is also not helping. After getting result, I spent entire day in reading positive ivf stories on internet I know that in this journey nobody get success immediately, every couple have their shares of failures and sorrows before getting positive result. But when we will achieve success? This question always comes in mind.

We have stop to share about our treatment process with family members, for last one year. 

They start expecting a lot, as for them ivf means 100% success. They don't understand the statistics behind it. Some of them give advise for adoption. So we decided not to reveal about treatment process. If there is any family function in between treatment cycle we give other reasons for not attending it and seriously I don't enjoy such get togethers now a days. My mother pray for me constantly but I do not want to discuss this with her also as she gets more depressed due to my pain. I only talk about it when she ask. But sometimes we feel very alone in such situations as nobody is there to share our grief.

We want to take some time off and go somewhere for relaxation. But we can't plan vacations thinking that instead of spending on it, let's save for the treatment. Life is a struggle for everyone, it's reasons are different but struggle to have a baby is something else... I mean it's a simple, biological process but couples  like us have to go through a lot to get our dream baby. My heart cries when I read about people doing abortion for unwanted baby, people abandon newborn babies on roadside and moreover kills the girl child in desire of a son... I mean how can this be tolerated by supreme power whom we called as GOD...

And such kind of people get opportunities of bearing child again and again to repeat their mistakes... this is beyond my thinking.

I married at the age of 30, started seeking treatment at the age of 33 and now approaching my 40s. Now wonder if my age will make it difficult to achieve success?  This 7 years of journey consist of HSG, plenty of blood work, lots of pills and injections, numerous scans, laparoscopy, hysteroscopy , 8 failed iui, 6 failed embryo transfer, one missed abortion, financial loss and what not.. 

Yet we try to be happy in other things in life. We meet and greet people with smile on face. We also like to see half glass full. We shower our love on our sibling's children, we spend quality time with them. This gives us some peace of mind but desire to have our baby just keep rising n rising. Irrespective of the result, we know that whatever we are doing is our best. Things happens as per plan, it's process is in our control but outcome is not in our control. Our hope always overcome on our sorrows and we bounce back to try one more cycle. No other option but to say this, Time heals everything.

I do remember serenity prayer to keep spirits high but believe me it's not easy...

Corporate chains versus boutique clinics for IVF treatment

It's great to see that so many corporate chains of IVF clinics have come up all across India.

The advantage is that now patients have access to IVF treatment even in small towns, and they don't need to travel to large cities to get IVF treatment.

This makes it much more convenient for them, and hopefully a little more affordable as well.

However, the problem is that the major motive behind these corporate chains is to maximize their profits, rather than to do what's in the patient's best interests.

This often means that they use an assembly line procedure, and their doctors are forced to meet targets and do  a certain number of IVF cycles every month, to get paid their bonuses.

As a result of this, their focus is on trying to get as many patients to do IVF as possible.

This is why they advertise so aggressively, and buy so many billboards . This is also the reason they offer so many free medical camps for infertile couples – to try to increase their throughput and do more IVF cycles.

Yes, this is in their best interest, but is not in the patient's best interest, so you need to be careful ! As the saying goes – Let the buyer beware !

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 getting pregnant with IVF

When to do SET ( Single Embryo Transfer) from Dr Aniruddha Malpani

Why I get upset with IVF patients

Is donor egg IVF the right option for you ?

The attitudes of patients towards having to use donor eggs can vary a lot !

Many older women have poor ovarian reserve , and they know that the best way of having a healthy baby is to use donor eggs. However, lots of them find it very difficult to come to terms with this.

They believe - It's not going to be my child because my baby is not going to carry my DNA. This is why they point-blank reject this option and refuse to explore it.

On the other hand, there are other women who say, "Look, at the end of the day all I want is a baby. The DNA doesn't really matter , because as long as I love the baby , this will by my child."

They are very happy to accept this option , and are grateful that not only are there young women who are happy to donate their eggs, they're also pleased that the technology exists today to take advantage of this treatment – something which simply wasn't available 40 years ago.

The acceptability of using donor eggs depends on the attitude of the patient and what they really want from fertility treatment – the propagation of their DNA ? the pleasure of experiencing pregnancy ? or the joy of bringing up a baby ?

You can download the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdfand 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 IVF doctors want from patients.

Just as the role of the doctor is extremely important in IVF treatment , so is the role of the patient because it's ultimately a partnership. And we want patients who have realistic expectations of the IVF treatment and understand that nothing has 100% success rate, that they're going to have to be patient in order to achieve success, and if they're lucky, yes, they will get pregnant the first cycle but it may take two or three.

We want our patients to be willing to trust us, to respect us as professionals, that we're doing what's in their best interests. But equally importantly we don't want them to just give the trust away and we're quite happy to earn it by being transparent and open and sharing information with our patients. But they need to understand enough about IVF to be able to appreciate the value of what we are saying, so that this can then become a mutual partnership where both doctor and patient respect and trust each other to high success rates.

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 !