Simplifying IVF - what IVF patients need to know !

Which kind of IVF patients are we the best doctors for?

What will my donor egg IVF baby look like?

Making sense of IVF treatment

LH as the villain in IVF protocols.

The purpose of an IVF superovulation protocol is to help you grow lots of follicles, which is why we use gonadotropin injections which contain 2 hormones - FSH and LH.

One of the problems is that the LH hormone can sometimes play the role of a rogue.

If there is an early LH surge, the follicles can rupture too early , and we may not be able to pick up an egg at all.

This used to be a major problem in the past, which has now been solved by using either GnRH agonists, or  GnRH antagonists, which prevent these LH surges.

Sometimes the LH surge may not be enough to cause premature follicular rupture, which means we can still collect eggs. However, a minor LH surge can cause premature luteinization , and as a result of the high progesterone levels this causes on the day of egg collection, the endometrial receptivity may be compromised.

This is why many clinics are now freezing all the embryos, so we do not transfer embryos in the fresh cycle at all. We can then transfer the frozen embryos in a follow up cycle , where we can prepared the endometrium for optimal receptivity using exogenous hormones such as estradiol.

Find this confusing ? You can't afford to remain clueless ! The good news is that it's easy to figure out  by downloading  the IVF comic book free at <https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf>

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

WhatsApp us at https://wa.me/919867441589/

Embryo pooling for patients with poor ovarian response

The commonest mistake IVF patients make

A lot of IVF patients can be exceptionally naïve . They believe that all IVF clinics are created equal, which means the success rates in all clinics are the same. But this is not true, and new clinics , or clinics which are part of corporate chains are often not able to provide the kind of personalized attention and handholding which small boutique clinics can.

And this is why it's so important that patients do their homework before actually signing up for an IVF cycle.

At the time of the first consultation , the IVF doctor does his best to get you to sign  up and is happy to take your money away from you, but you really don't know what you're getting into if you don't ask the right questions !

The way to find out if they are they going to able to provide high-quality care is by asking 3 simple questions - Do they routinely provide photos of embryos? Do they do blastocyst transfers routinely for all their patients ?  Do they freeze spare embryos routinely ?

If you don't know the answers to these questions - or if you don't know what a blastocyst is - then this in itself is a red flag, because unless you do your homework you're not going to able to make out whether you're making a mistake when selecting an IVF clinic !

The good news is that it's easy to figure this out  !

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

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

WhatsApp us at https://wa.me/919867441589/

Are you fed up of being treated as a number in your IVF clinic?

Making sense of your IVF medicines

The superovulation protocol we use for IVF patients depends on two things.

One is the patient herself. For  example, what her ovarian reserve is , as judged by her age, antral follicle count, AMH level; and her historical response to previous IVF cycles.

The second variable is how many follicles we want you to grow. For example, if we want lots of follicles, we use a standard protocol, or an aggressive protocol, so we get lots of follicles . This allows us to collects lots of eggs, and this allows us to form many embryos , which we can then freeze and store.

On the other hand, if we don't want too many follicles ( for example, if we are worried about the risk of OHSS - ovarian hyperstimulation syndrome) , then we will use a minimal stimulation protocol so that we get only few eggs, and few embryos. Hopefully, these few ones will be the top quality ones.

This is a decision we make in partnership with our patients .

 If you understand your options, and can figure out what we're doing and why it, you'll be in a better position to be able to have an intelligent discussion with your doctor !

Find out more by downloading the IVF comic book free at

<https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf>

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

WhatsApp us at https://wa.me/919867441589/

No privacy in your IVF clinic?

Making sense of your IVF medications !

Many patients get confused by all the medicines and injections which are used in an IVF cycle, and this is partly because doctors themselves are very confused.

You need to step back and look at the big picture to make sense of the technical minutiae.

All we're trying do when we super-ovulate you is to help you to grow lots of mature eggs. We want you a synchronous cohort of follicles, all of which are roughly the same size.

In order to do this, we have to give you hormones  to stimulate your ovaries, which normally produce only one mature follicle ( which contains only one mature egg) every month. These could be by bumping up the level of your own endogenous hormones, by using Letrozole, which increases the FSH produced by your pituitary.

We can also give you hormones in the form of injections. These are the gonadotropin hormones - FSH and LH. These could be urinary gonadotropins, or pure recombinant FSH.

We adjust the dose, to get you to grow lots of follicles, and when the follicles are mature, we then trigger ovulation using HCG , so that we can then retrieve your eggs and send them to the embryologist in the IVF lab, where he can fertilise them.

Which particular protocol we use depends on various factors, including your age, your previous ovarian response, and how many follicles we want you to grow.

Along with the gonadotropins, we also use GnRH agonists or antagonists, to make sure your follicles do not rupture on their own !

You can learn more about IVF treatment by downloading  the IVF comic book free at

<https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf>

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

WhatsApp us at https://wa.me/919867441589/

Which hormone injection works best in IVF ?

There's still a lot of confusion as to whether we should use urinary gonadotropins or recombinant gonadotropins in IVF for superovulation ( = helping patients grow lots of follicles).

Historically, we used urinary gonadotropins for many years. These are biological products , extracted from the urine of menopausal women , and they still work very well.

The problem is that there is a lot of batch to batch variation , because the quality of the extracted hormones is not always consistent, and this can create a lot of problems, because patients don't respond well to the superovulation. This is why it's so important for doctors to insist on seeing the bioassay report of every batch of urinary gonadotropins which they use for their patients.

This is why the newer advance is to use recombinant DNA technology to produce rec FSH in the lab in vitro. These are  much purer molecules, but the problem is they are more expensive , and this adds to the patient's financial burden .

This is why  it's important to use a judicious mix of the two.

Their efficacy as far as growing follicles is exactly the same, but some doctors worry because of the LH which urinary gonadotropins contain , because LH is considered to be a villain in IVF.  However, in clinical practice, it makes absolutely no difference to IVF outcomes at all.

Want to make sure you are getting the best possible IVF treatment ? You can download the IVF comic book free at

<https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf>

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

WhatsApp us at https://wa.me/919867441589/

Embryo pooling for patients with poor ovarian response

Lots of patients who have a poor ovarian response end up getting only one or two embryos in an IVF cycle . Their options are to transfer the fresh embryo in the IVF cycle; or to freeze them, one at a time , store  and pool them, and then transfer them later on, one at a time, after thawing them.

The reason this is a better option is because time is at a premium for patients with poor ovarian reserve. Transferring an embryo and then waiting to see whether a pregnancy occurs or not ends up consuming a lot of time. It makes more sense to do 3-4 egg collection cycles , back to back , and therefore collect lots of eggs , and as many embryos as possible , within a short span of time.

Once your embryos are frozen, you now have the luxury of time of being able to transfer these embryos back into your uterus whenever you're ready. You don't have to worry about the ticking of your biological clock damaging your chances of getting pregnant, because your embryos are safely frozen !

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

WhatsApp us at https://wa.me/919867441589/

Are you fed up of being treated as a number in your IVF clinic?

Does your IVF clinic seem to be an assembly line where they're more interested in extracting your money rather than treating you as a human being?

Do you feel that there's no overall treatment plan or continuity, and that every time you go to the clinic you meet a different doctor - usually an assistant or a junior - who has no idea what's happening?

Do you find that you have to wait for hours on end with no clarity at all?

Do you find that no one is willing to share medical records with you or give you any details as to how your treatment is progressing?

Do you find that there always seem to be last-minute changes in your treatment protocol based on some arbitrary reason , and no one gives you an answer as to what's happening?

Do you feel that after you've paid your money they only treat you as a wallet rather than as an infertile woman who wants to have a baby deeply?

If so, then please come to us for your treatment. We're a boutique IVF clinic where only Dr. Anjali and I take care of all our patients personally. We're very hands-on, experienced, expert and empathetic !

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

WhatsApp us at https://wa.me/919867441589/

No privacy in your IVF clinic ?

IVF can be a very personal touchy, sensitive issue.

When you go to an IVF clinic, you expect your doctor to respect your privacy and talk to you one-on-one, because you want to share things which you're not comfortable sharing with other people.

Unfortunately in most IVF clinics, this privacy is sacrificed. There is a rush of patients , which means there are often two or three patients crowding around the doctor at the same time. Often, the consulting room door is wide open, which means other patients can hear the conversation you are having with the doctor, when he says thinks like, "Yes, you need to use donor sperm" or, "We should consider using donor eggs."

This is disrespectful of the patient's needs ! It's high time IVF doctors learnt to respect patients' needs - after all, they charge so much, and they can't just concentrate on maximising their income by trying to see as many patients as possible in a short time.

It's far more important for IVF doctors to make sure that patients feel cared for !

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

WhatsApp us at https://wa.me/919867441589/

Which kind of IVF patients are we the best doctors for?

A single IVF clinic cannot possibly be right for all IVF patients . This means patients need to make a trade-off when selecting an IVF clinic !

Should they go to the cheapest ? the nearest ? the most well known one ? the one who advertises the most ? the one who holds free camps ? the one who their GP sends them to ?

I believe every doctor gets the patient they deserve, and every patient gets the doctor they deserve.

This is why it's very important that the patients who come to us are those who appreciate the unique value which we add to IVF treatment.

What makes us special is we have a lot of experience and expertise, and because we don't have any assistants, all the care we provide is very personalized, bespoke, and hands-on .

We focus on making sure that we maximize your chances of getting pregnant , by doing exactly what's right for you , because we use the latest technology and apply it intelligently to your needs.

This is why we are the best bet for patients who value doctors who respect them ! We want patients who are seeking doctors who have the time to talk to them, and who are transparent and open .

We take pride in treating challenging patients who have failed IVF cycles in other clinics !

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

Clinic Mobile: 9867441589 

WhatsApp us at https://wa.me/919867441589/

Making sense of IVF treatment

One of the problems with IVF treatment is that patients still don't understand what the process involves.  Not only doctors love complexifying the process ( so they can charge more for it !), there are so many myths and misconceptions floating around - both online and in the real world, that they don't know whom to trust.

Most of them assume that it's too complicated for them to understand, and are happy to leave everything upto their doctor. This is why they are very vulnerable, and it's easy for unscrupulous doctors to tale them for  ride, by using tons of jargon - and using this as a pretext to charge more for every additional service they offer - most of which are not needed at all. Sadly, patients can't push back, because they are so clueless about the process.

All you need to understand is that IVF is just the final common pathway which doctors can use in order to help you have a baby - it's a solution which allows us to bypass all the problems which can cause infertility. The good news is that that once you get pregnant after IVF, it's like any other pregnancy.

Think about it this way. Normally, the egg and the sperm fertilize and form an embryo in the fallopian tube , when fertile couples have sex in the bedroom. This embryos reaches the uterus after five days, and it then implants in the uterine lining.

Now, any problem in the bedroom - either with the sperms or the eggs or the tubes - can prevent this from happening, and cause infertility. In IVF, we fertilise the eggs with the sperm in the test tube, so that the embryo then spends 5 days in the test tube, instead of the fallopian tube ! After 5 days, we transfer the blastocyst back in the uterus, and if it implants, this is exactly like a normal pregnancy !

You can download the IVF comic book free at 

<https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf>

What will my donor egg IVF baby look like?

One of the biggest concerns which patients who do donor egg IVF have is - What will my baby look like?

They have to take a major leap of faith, because they don't get a chance to see what the donor looks like. They major worry is - Will my baby resemble me , or will people know that I've used donor eggs? Will my baby be intelligent ? Will my baby behave the way I do?

It's normal to have lots of concerns, ICMR rules in India don't allow us to show photographs of egg donors, because egg donation in India has to be confidential and anonymous.

That's why we reassure patients, and tell them that by using frozen donor eggs, we can match physical traits. However, at the end of the day, it's impossible to predict what a child look like  - after all, biological siblings don't looks like each other either !

You can read more about our donor egg IVF program at http://donoreggs.in !

However, at the end of the day , your child will pick up your behavior, your habits, your mannerisms, because you're bringing up your child. This is why siblings resemble each other - not because of their physical traits , but because they imitate their parents, and absorb  the way they talk, smile, and behave . After all, let's not forget that husbands and wives also start resembling each other after some years as well !

When doctors cause infertility !

The biggest tragedy in reproductive medicine is when patients are made infertile as a result of the doctor's treatment !
This hurts , because when you go to a doctor , you want him to help you to have a baby . However, when instead of doing so , he actually makes you infertile by doing the wrong treatment, this just adds insult to injury and makes you bitter and angry !
A classic example is women who have a missed abortion .
The standard method in the past for treating this was by doing a D&C . Today, thanks to advances in medicine, it's possible to terminate this pregnancy medically , using medicines such as Mifegest and Misoprostol , which allows the uterus to naturally empty itself. This is far safer for the patient, because the problem with the D&C is that it can cause intrauterine adhesions ( Asherman syndrome) , which damage the uterine lining, and prevent the women from getting pregnant again in the future . 
Sadly, many doctors don't offer the medical treatment option to their patients. They continue scaring them and forcing them to do a D&C , because this is much more profitable for them . It's quick and easy surgery , and they can charge for doing it . Since they can't charge as much for prescribing drugs, , they push patients into going into the operation theatre , even though this is not in the patient's best interests.
Now well-informed patients know that there is a medical option available , but even for these patients, it's easy for doctors to bulldoze them into doing surgery by saying - Your baby is dead , and this poison can then spread into your body , which is why it's urgent that we remove the baby right now , and surgery is the fastest and quickest way of doing this, and just takes a few minutes !
They scare the patient by telling them that medical abortions are painful , and have a higher risk of complications. 
However, the reality is the complication risk is much higher with a D&C , as compared with the medical procedure .
When patients realise afterwards that they been made infertile because of an unnecessary surgical procedure , they are very bitter , and refuse to trust any doctor in the future !

Iatrogenic infertility

Being infertile is bad enough, but when the infertility is caused by an infertility specialist, this makes it much worse !

Sadly, we continue to see lots of patients, whose fertility has been damaged because of poor quality treatment.

Here is an example ( names withheld to protect the guilty !)

I have a very low amh of 1.16. I have undergone 3 cycles of IUI from Dr G, a gynecologist, none of which were successful. After that, I underwent laparoscopic  surgery by Dr H, an IVF specialist, for removal of endometriosis cyst. During the procedure , the doctor discovered I had a hydrosalpinx in both my fallopian tubes , so they clipped it . This means now I can't concieve naturally. After a month break after the laparoscopy , I did two cycles of IVF , but both have failed. I have spent almost Rs 10 lakhs and this is now a big stress for me. What should I do next ?

This poor patient has had poor quality treatment, even though she has gone to brand-name leading IVF specialists.

There has been a litany of errors in her treatment, and the tragedy is that this is a common story we see

For one thing, there was no need to do an operative laparoscopy for the endometriotic cyst. This is unnecessary surgery , which does not help improve IVF success rates at all. It actually reduces fertility , as normal ovarian tissue is also removed along with the cyst wall, thus reducing ovarian reserve, which is exactly what has happened in this case.

Secondly, lots of doctors seem to be very keen on clipping the tubes for patients who have a small hydrosalpinx which is detected incidentally during the laparoscopy. This is best left alone, and clipping the tubes doesn't help at all - but ensures that the patient will now always need IVF if she wants to have a baby !

Cysts can always get be aspirated ( punctured) under ultrasound guidance ; and small hydrosalpinges should be left alone. The trouble is that most doctors have a knee-jerk reflex of " treating " any abnormality they find, even if it does not help the patient at all !

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

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

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