Sunday, December 29, 2019

Is your IVF doctor using you as a guinea pig ?

All of us believe that as medicine advances, IVF pregnancy rates will constantly keep on improving, and this is perfectly normal. After all, science does progress , and IVF pregnancy rates today are much better than what they were 10 years ago.
Unfortunately , this expectation also gives rise to the phenomenon of treatment creep . Doctors start introducing all kinds of new ancillary procedures , even though they haven't been proven to be effective.
Part of the problem is that many doctors are very optimistic that something which is new will be more effective better than the current solutions. We are always under pressure to try out the latest technique , and most doctors are competitive, and happy to be the "first" one to introduce something new !
The pressure to "publish or perish" also means that researchers and scientists spend a lot of money on publishing positive results papers in academic journals. Sadly, most of these results can't be replicated by others !
Both pharma companies and medical device companies are also happy to sell what's new. After all, they can charge a premium for this, which means they advertise and market this heavily, at medical conferences and in medical journals.
Doctors are under a lot of pressure from patients to do something new - or something different.  After all, what 's the point of trying out the old stuff again, if it has failed once ?
And because doctors are human and get carried away by their anecdotal successes , it's easy for them to justify doing new procedures, even when they haven't been proven to be helpful. And the fact that this gives them an excuse to charge more is icing on the cake for them !

Are you worried that your doctor is using you as a guinea pig ?
What to find an IVF clinic which respects your time and intelligence ?

Saturday, December 28, 2019

Why it's safe to take medications after your embryo transfer

 A lot of IVF patients are very worried about taking any medication at all during the 2ww( two week wait).
For example, if they get a cough or a cold or a diarrhea, they're not sure whether it's safe to take medicines to treat this.
The reason is they're worried that these medicines will have an adverse effect on the embryo which is in their uterus. They know that some medications are dangerous during pregnancy , and are worried that these will harm their embryo.
The truth is that it's safe to take any medicine you need to during your 2ww, until your HCG test is positive.
This is because even though your embryo's inside your uterine cavity, it's still not implanted. Because it has not established a blood supply from you , the drugs you take will not be able to cause any harm to your embryo because they can't reach it through your blood stream.
This is why you don't need to worry at all !
Just like women continue taking medications after having sex in their bedroom, there's no reason for you to take any special precautions about any medicines after the embryo transfer either.

What to find an IVF clinic which respects your time and intelligence ?

Sunday, December 22, 2019

When IVF can be a blessing

Being infertile can be stressful, and so can going through IVF treatment .
However, there is always a silver lining to every cloud, and we need to remember that going through IVF can be a blessing as well !

Thus, we know that IVF patients become better parents than ordinary parents. This is hardly surprising, given the fact that you've worked so hard in order to get a baby !  You don't take your baby for granted, unlike most other parents, and spend much more time and energy on parenting, simply because you realize how precious children can be.  You are grateful that you have them, and treat them as a blessing. IVF children actually have a head start in life !

And it's not just that IVF patients make better parents - they make better spouses too ! If you have the maturity to withstand the stress of an IVF cycle, your marriage is going to be much stronger than an ordinary marriage.

Finally, IVF helps you become a better person, irrespective of whether your IVF cycle fails or succeeds, because it teaches you to cope with adversity, and teaches you how to manage your emotions.  Going through suffering helps you become more empathetic , and a better human, who is more willing to help others !

What to find an IVF clinic which respects your time and intelligence ?

Monday, December 09, 2019

IVF video - Bad IVF doctors and how to protect yourself !

IVF video - Bouncing back after a Failed IVF Cycle !

The role of "fate" and "luck" in IVF

Embryo implantation is a still a "black box" as far as medical science is concerned, because we can't predict or control which embryos will implant. This is hardly surprising, given that it's a complex biological process, which involves an intricate interchange of signals between the embryo and the uterine lining.

There are lots of factors which determine success, and while we know what some of these are, many are still beyond our comprehension.
For example, we know that a top quality embryo has a better chance of resulting in a pregnancy, as compared to a poor quality embryo.
However, we also know that not every perfect embryo transferred into a perfect endometrium will implant! This causes a lot of heartbreak and distress, but this is because there are many other factors which determine success, which we don't know enough about ! These include: genetic factors; epigenetic factors; and immunological factors , all of which have still not been analysed in sufficient detail.
At present, we are forced to include these under the rubric of "luck", "karma" and "fate" - which aren't very accurate or helpful ! Patients want more accuracy from their doctors !
Thus, if a patient does not get pregnant after the transfer of a top quality embryo into a receptive endometrium, we attribute this to "bad luck". Often, all we can do is repeat the cycle until her luck changes !
It's partly because there is so much about IVF that we don't understand that both IVF specialists and patients are so easily swayed by anecdotal case studies. This is why there are still so many useless and unproven "treatments" which plague IVF today, including: endometrial scratching; endometrial receptivity assays; PGS ( preimplantation genetic screening); and treatment with "stem cells". While these are very profitable for the clinic to offer, the truth is that they haven't been shown to improve clinical pregnancy rates in clinical studies.
This is why research and development is so important. However, it's not fair to use patients as guinea pigs - and to charge them for expensive and unproven "treatments" under the guise of their being the "latest technology" .

What to find an IVF clinic which respects your time and intelligence ?

Friday, December 06, 2019

IVF video - How to Stop Feeling Miserable - Coping with Infertility !

The known and the unknown in IVF

One of the reasons IVF outcomes are so unpredictable and uncertain is because it's a complex biological system, and there are lots of factors which determine success.
It's useful to think of these in terms of known factors ; and unknown factors .
For example, we know that the quality of the embryo ; and the endometrial thickness and texture will influence the chances of embryo implantation.
However, we also know that not every perfect embryo transferred into a perfect endometrium will implant, which clearly means there are lots of other factors which determine success, which we don't know enough about !
These include: genetic factors; epigenetic factors; and immunological factors , all of which still need to be studied and analysed.
At present, we include these under the rubric of "luck" and "fate" - which aren't very accurate or helpful terms !
This is why research and development is so important, and advances in reproductive science will ensure that the number of known factors will increase , while the unknown factors will progressively decrease.
However, it's still not possible for us to be able to measure or improve all the unknown factors, which is why we still can't predict which IVF cycle is going to be successful , and which one isn't.
We try to use all the technological tools available at our disposal, but our answers are not perfect and we need to live with this !

What to find an IVF clinic which respects your time and intelligence ?

Wednesday, December 04, 2019

How IVF patients can use Dr Google intelligently !

A lot of husbands get worried because their wives spend so much time on Google.
After all, being infertile can be stressful and infertile women are hungry for information , which Dr. Google provides in abundance !
This is especially true when you're going for an IVF cycle, but a lot of family members don't like women obsessing over IVF websites.
For one, they are worried that they will start thinking of themselves as being half doctors - after all, isn't half knowledge dangerous ? Yes, it is , but this doesn't mean ignorance is bliss either.
Their bigger worry is that they will start worrying needlessly, especially because so much of the information available online is unreliable. All this worrying can't possibly be good for them , because it increases their stress levels !
Yes, they have a valid point, and simply want to protect them from anxiety.
However, we need to take a supporting attitude, rather than being judgmental  ! The good thing about Dr. Google is it teaches you what you don't need to worry about , if you are a smart user.
It helps you understand what's in your control - and equally , what's not in your control, so you stop obsessing pointlessly over stuff you can't do anything about. Knowledge is power when used well !
This means there's no need to stop using Google, but it's important to learn how to use Google intelligently. The good news is that Google can teach you how to do this as well, by helping you to identify which websites are reliable, updated and accurate !

What to find an IVF clinic which respects your time and intelligence ?
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Tuesday, December 03, 2019

IVF Video - How IVF Doctors lie to patients !

IVF video - We need to Stop Medicalising IVF Treatment

Why single embryo transfers are a better option

Many IVF patients want us to put as many embryos back as possible , because they want to get pregnant as quickly as possible, and they know that the more the embryos they transfer, the better their chances of conceiving. This is why some clinics will routinely put back three or four embryos at a time.

I actually think this is irresponsible , because it increases the risk of a multiple pregnancy. Some of these patients end up with premature labors, which means their babies spend months languishing in a NICU, and maybe handicapped because of the prematurity. Even worse, the doctor does a selective fetal reduction to "treat" a high order multiple pregnancy, and this causes the patient to miscarry and lose all her babies . You can imagine the amount of heartburn this causes !  This is why a single-embryo transfer is much safer.

Interestingly, the pregnancy rate is also better with a single-embryo transfer, which means you can have your cake and eat it too ! Please remember that you can't compare apples and oranges , and you need to compare a double embryo transfer with the cumulative pregnancy rate of two sequential single embryo transfers.

Let me explain. Suppose you have two embryos, and suppose the chance of each embryo implanting is 30%. Now suppose you put both the embryos at one time, then yes, the chance in that cycle will increase to, let's say, 45%.  However, if you don't get pregnant, you will have no spare embryos left, and will need to start a fresh cycle all over again. However, if you did only a SET, you can still transfer the single embryo. The pregnancy rate with this will remain 30%, which means your cumulative pregnancy rate is 30  + 30, which is 60%, which is higher than transferring 2 embryos at a time !

Of course, this applies only to good IVF clinics, which transfer only top quality blastocysts, and have a robust embryo vitrification program.

What to find an IVF clinic which respects your time and intelligence ?

Saturday, November 30, 2019

How IVF patients add to their stress levels

IVF patients are stressed out because they're not sure whether their IVF  cycle is going to work or not.
And since everyone knows that stress is not good for patients, they try to reduce their stress levels by providing them with a protective environment.  Many family members  - especially the older ones - impose all kinds of dietary restrictions after the embryo transfer,  under the assumption that some foods are "hot" or cold" and may harm the embryo. Many still insist that patients remain on bedrest and not perform any physical activity, because they think this will dislodge the embryo !
However, they fail to realize that their loving concern can actually backfire ! This can have a counterproductive effect , and often ends up increasing their stress levels.
Women who are forced to stay in bed often end up getting sick ! An idle mind is a devil's workshop, and they keep on brooding about whether they are going to pregnant or not. This just makes going through the 2ww a greater mental torture !
Also, bed rest causes the back to hurt; muscles become stiff; and pelvic blood flow decreases.
Please remember that once an embryo is inside the uterus, there's nothing we can do to influence the outcome  either way, since implantation is a biological process we cannot control. An embryo is the uterus is safe and secure - think of it as being a pearl in an oyster !
Please remember that women going through IVF are not patients - they are healthy women, and we are using IVF only to assist them to start their family !

What to find an IVF clinic which respects your time and intelligence ?


Tuesday, November 26, 2019

IVF video - Male Infertility Treatment and Why it Does not work?

IVF process and IVF outcome

Part of the problem with IVF treatment is that no matter how well we follow the process, we can never be sure about the outcome.
This is because even if we produce top quality embryos , and put them back in a perfectly receptive endometrium, pregnancy rates are never going to be 100% , because we can't control embryo implantation. Human reproduction is not very efficient - and this is true in the bedroom, and the clinic as well !
The problem  is that patients can't judge by the process, because this happens inside the lab. They can only judge by outcome, and when the cycle fails, patients are understandably upset and angry.
This is why we spend so much time and energy trying to educate patients , and reminding them that IVF outcomes are not in a doctor's control !
This is why they need to understand as much as possible about the IVF process, so they can see if the doctor is following  the process properly or not.
This is why we are such sticklers for following the right protocol, and emphasising openness and transparency.
This is the reason good IVF clinics give photos of embryos routinely to patients, so they can see the clinic has done what was in its control properly ! This creates trust and confidence, so patients have peace of mind they are getting the best possible medical care.

What to find an IVF clinic which respects your time and intelligence ?

Monday, November 25, 2019

IVF video - The poor Infertile Man!

IVF video - Unnecessary Testicular Surgery for the Infertile man!

Why did my IVF cycle fail ?

Whenever an IVF cycle fails, patients ask two questions.

Did we overlook something ?
Can we do anything different the next time?

And the unasked question is - Did the doctor mess up?

When an IVF cycle fails, doctors are heartbroken too , just as patients are.

We want our patients to get pregnant as quickly as possible , because every time a patient gets pregnant, she's going to refer more patients to us for IVF treatment.
The trouble is that our IVF technology has limitations , and we're not very good at determining why a cycle fails.

Thus, we can check endometrial receptivity by checking the endometrial thickness and texture on the ultrasound scan, but this is a crude test. Not all endometrial linings which look normal on ultrasound scans are actually going to be receptive.

Sadly, we still don't have enough reliable tests to be able to differentiate between a receptive endometrium and one which is not.

Researchers have developed tools such as the ERA ( endometrial receptivity assay), which many IVF clinics promote aggressively, but these tests are unreliable, and their  signal noise ratio is not good enough to use in clinical practise. Sadly, the rule GIGO - Garbage In, Garbage Out, still applies. More tests don't improve clinical outcomes or IVF success rates

In real life, what this means that sometimes patients just need to be patient after a failed IVF cycle, and repeat the process until it finally works !

What to find an IVF clinic which respects your time and intelligence ?

Tuesday, November 19, 2019

IVF video - Learning from a Failed IVF Cycle !

IVF video - Factors Affecting the Success of IVF Treatment Cycle

Prevent IVF sperm mix-ups ! Good News Trailer | Akshay Kumar | Kareena Kapoor | Diljit Dosanjh | Kia...

One of the major worries every IVF patient has is that the IVF clinic will mix up their sperm with someone else's !

The film, Good News, pokes fun of this worry in a humorous fashion, but the fact remains that lots of IVF couples will worry about the risk of a mix-up.

It's important that patients speak up about their concerns with their IVF doctors - and good clinics follow strict processes to ensure this mix-up does not happen !

You can read more about the quality control checks we use at

Make sure your IVF clinic follows these too !

Monday, November 18, 2019

Good News Trailer | Akshay Kumar | Kareena Kapoor | Diljit Dosanjh | Kia...

While IVF is not a joking matter, I am glad movies like Good News are using humour , so that it's now possible to openly discuss these previously taboo topics !

Vicky Donor did this for sperm donation, and Good News will do this for IVF - and for medical mix-ups and medical errors.

Hopefully, it will also encourage doctors to talk more openly about what we do to prevent medical errors !

Our book, Patient Safety - Protect yourself from Medical Errors, has a chapter on preventing errors in IVF at

Good News and the truth about IVF | Akshay Kumar | Kareena Kapoor | Diljit Dosanjh | Kia...

One of the comments questions newly married couples in India are asked is - Any good news ?

This is partly thanks to Bollywood , where it seems that everyone gets pregnant the first night they have sex !

Sadly, human reproduction is not as efficient as the fervent imagination of a Hindi film director , and it takes time for humans to make babies .

About 15% of married couples will find it hard to get pregnant , which is where an infertility specialist has such an important role to play .

IVF as a treatment option is very successful in bringing good news to infertile couples who want to complete their families.

To learn more about IVF, you can download the IVF comic book free at

IVF video - How to tackle the Infertility Blues?

IVF video - Uncertainty in IVF!

IVF video - Counselor's Role in Infertility Treatment

Friday, October 25, 2019

Hallmark of a bad IVF clinic

IVF patients are often unsure how to select the best IVF doctor, because they all seem very similar.
However, one thing you can be sure about is that if the clinic is putting pressure on you to start your IVF treatment as quickly as possible, then this is a red flag. IVF treatment is elective treatment - and when to do it is a decision which you need to make for yourself. It should be driven purely by personal patient preference. A good doctor will do a consultation; offer you counselling; explain your options; and  give you a cooling off period, so you have time to make a well thought out considered decision.
After all, there are always options, including adoption ! Once you go back home, you can process the information provided; maybe get a second opinion; and talk to other people in your family and get their inputs, if you think these will help .

Sadly, a lot of IVF clinics today are set up with only one intention - to get the patient to start an IVF cycle as quickly as possible , before they change their mind !
This is actually very harmful for patients , because then all the clinic is bothered about is maximizing their income by doing as many IVF cycles as possible, irrespective of whether the patient needs it or not.

What to find an IVF clinic which respects your time and intelligence ?
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Thursday, October 24, 2019

How to minimize IVF risks

Infertile couples often forget that the biggest risk of IVF is not doing IVF !
IVF patients are understandably worried about some of the side effects and complications of IVF, such as multiple pregnancies or ovarian hyperstimulation syndrome ( OHSS) , but the biggest risk for an infertile couple is that may end up with no baby at all ! Not doing IVF has a huge opportunity cost, and infertile couples need to factor this in.

One way of minimizing this risk is to do IVF, because it's the one treatment option which maximizes your chance of getting pregnant , because it has the highest success rate. By maximizing your chance of getting pregnant, you are also minimizing your risk of not having a baby. 
You also have peace of mind you did your best, so you have no regrets later on in life !

Yes, doing IVF does involve emotional and financial risks, but at the end of the day, it's a good idea taking these risks , because the reward is well worth it !

What to find an IVF clinic which respects your time and intelligence ?

Saturday, October 12, 2019

The biggest risk of doing IVF

IVF patients are anxious before starting an IVF cycle, and it's easy to understand why. IVF is an expensive treatment, where the outcome is uncertain, and no one is sure whether the cycle will succeed or not. Also, they are worried about the risks of taking all the injections, because they are scared about their side effects.
However, they worry about the wrong things ! The truth is that IVF is a safe , tested and effective treatment, provided it's done in a good clinic .
The biggest risk is one patients are often unaware of - choosing the wrong doctor.
The reason most patients are blissfully clueless about this is because they naively assume that all doctors are created the same.  Also, they don't think they're competent enough to differentiate between a good doctor and a bad doctor, and are happy to go to the one who is nearest/cheapest/ has been recommended by their GP .
This is the biggest mistake they make, because if you end up in the clutches of a bad doctor, not only will you end up wasting a lot of money, you also actually end up running the risk of unnecessary complications , such as high-order multiple pregnancies , or ovarian hyperstimulation syndrome ( OHSS) .
Please do your homework before you sign up for an IVF cycle !

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Friday, October 11, 2019

Why do perfect IVF cycles fail?

Often an IVF cycle goes perfectly , and the doctor is happy with the medical process. He has transferred a top quality blastocyst; the transfer was smooth; and the endometrium was 8 mm and trilaminar.
However, even though everything seems to be perfect, the IVF cycle may still fail.
Patients then feel  cheated and upset ! After all, if the cycle was perfect and the doctor was so happy and hopeful, then why didn't it work?
What they forget is that when we call a cycle perfect, we only refer to the medical tangibles  which we can measure. Our technology is still not good enough to allow us to assess all the hundreds of variables which influence implantation.
Thus, we look at the morphology of an embryo and grade it, but we can't check its genetics. Similarly, while we can see that the endometrium is thick and trilaminar on an ultrasound scan, this doesn't necessarily mean that it's receptive, and we don't have the tests to be able to assess this.
It's because our technology is limited that a perfect IVF cycle doesn't always end in a pregnancy.
This is something we need to learn to live with, because reproductive science is still not perfect.

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Thursday, October 10, 2019

Why does the IVF technique mostly result in twin pregnancies?

This is a very common misconception.
Part of the reason is that twins are far more memorable than singletons. This is specially true if the birth of the twins has happened after many  years of infertility , because of IVF.
On the other hand, singleton IVF pregnancies are not very memorable - and infertile couples will often not even share the information that they did IVF to get pregnant.
Also, multiple pregnancies after IVF used to be much commoner in the past , because many IVF clinics would transfer multiple embryos at one time. They didn't have very good success rates, and  in order to increase the chances of success, they would put many embryos in the hope that at least one would stick ! The problem was that if multiple stuck, patients would end up with multiple pregnancies.
This is an outdated practice today, because the complication rate with a twin pregnancy is higher. While many infertile couples are excited about the possibility of getting twins , because they think of this as an " instant family in one cycle", and while it's true that a twin pregnancy is better than not getting pregnant at all, the truth is that this is  not in your baby's best interests.
Global best practices recommend that you should transfer only a single blastocyst at one time , and freeze the rest. This way , the cumulative pregnancy rate is higher, and it's much safer for everyone !

Friday, October 04, 2019

Is IVF treatment stressful?

This depends on two important variables - the patient , and the clinic.
All patients who go through an IVF cycle are anxious , because they are concerned whether their cycle will work or not. They aren't sure  whether it will work the first time, or how many cycles they'll have to do , because they know that the success rate of IVF is not 100%. This uncertainty and anxiety obviously makes each cycle stressful . This is especially true of the two week waiting ( 2ww) period, because no one knows what's happening to the embryo which has been transferred into the uterus.
However, those patients who are well informed , and who have realistic expectations, because they have take the time and trouble to understand what an IVF cycle involves, find it much easier to cope with the emotional roller coaster ride, because they know that IVF is safe and effective are

The second variable is the clinic. Some clinics are very hands on , and will provide a lot of personalized attention to each individual patient. We don't have any assistants, and take care of all our patients ourselves. However, most large clinics are assembly line operations, who don't really care about the patient's state of mind . They needlessly add to the patient's stress, because of the long waiting times they subject patients too, and because the senior doctor is never available, and the care is delegated to inexperienced juniors.

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Thursday, October 03, 2019

IVF video in Hindi - 7 STEPS OF IVF (आई.वी.एफ. प्रक्रिया के 7 आसान चरण)

Is IVF painful?

Not if you do it in a good clinic !

Yes, IVF can be extremely painful in some clinics -  especially the ones who use intramuscular progesterone injections to provide luteal phase support after the transfer.
These are oily injections, which need to be given deep intramuscularly , as a result of which the patient's muscles become so sore and hard that they can't even sit on their backside !

These clinics are extremely unkind , and don't care about the comfort of their patients.
Clinics such as ours are much kinder, and we've never used intramuscular progesterone injections.

We do use progesterone , and give it in the form of vaginal suppositories . These doesn't cause any pain at all, which means there's no reason why an IVF cycle should be painful.  In fact, they are far better than the progesterone shots, because vaginal absorption of progesterone is much better than through the intramuscular route.

Also, we do our egg collections under general anesthesia. This is a short procedure, and patients have no pain at all, because they are fast asleep !

We take pride in being kind to our patients !

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