Friday, May 31, 2019

IVF WordCloud


This word cloud describes some of the topics I have covered on my blog over the last 15 years !

Multiple pregnancies as an iatrogenic complication of IVF.


Most patients are tickled pink when they see twin babies, and everyone knows that IVF increases the chance of having an IVF twin pregnancy.
This is why lots of patients want the doctor to transfer more embryos , so they can have an instant family , and this can make up for all their years of suffering from being childless
However, the complication rate in a twin pregnancy is higher than in singleton pregnancy - and this is true even if you are taking treatment in a good quality hospital.
The risk of premature labor is much higher , and these babies often will end up having birth defects and complications.
The best way of reducing this risk is by transferring only one single, top quality blastocyst at a time. We tell patients - You can have as many babies as you like, but only one at a time.
This is why I am surprised when IVF clinics celebrate the birth of triplets !
It's partly the media which is responsible for this, especially when it's a celebrity who has done IVF!

Doctors who transfer too many embryos are actually being irresponsible !\

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





Thursday, May 30, 2019

What went wrong doctor ?




Whenever an IVF  cycle fails, the first question patients ask is - What went wrong?
Now this is a very emotionally loaded term, because the moment you say, "something went wrong," it means that someone messed up ! Was it the doctor ? the nurse ? the embryologist ? or the patient.
This is the wrong way of looking at a failed IVF cycle.
Remember that when a husband and wife have baby-making sex, just because they don't get pregnant in one month doesn't mean anything went wrong, or that they did something wrong. They can't jump to the conclusion that they were having sex incorrectly, or his sperms are defective ! It just means that human reproduction is inefficient and that it takes time to achieve a pregnancy.
Now this is as true in the IVF clinic as it is in the bedroom - after all, we are just giving Nature a helping hand in the IVF lab, and substituting the test tube for the fallopian tube !
We counsel patients - "You need to take a longterm approach. You can't think of each IVF cycle on a single-cycle basis , because then you're very highly likely to give up , because it's such an emotional rollercoaster ride, and this can be very hard to deal with."
It's often a question of being patient and taking a long-term perspective. Yes, you will get pregnant - it;s just that we can't predict when this will happen.
Once you have found the right formula, and are transferring a top quality blastocyst into a receptive endometrium, then the secret for success is to stick to this, rather than keeping on experimenting and changing the protocol  every cycle out of desperation.

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/





Wednesday, May 29, 2019

Why older women have lower IVF success rates


The reason older women have lower success rates when they do IVF is because their eggs take a tanking as they age.
Both the quantity of their follicles ( as measured by their AMH level and their antral follicle count) as well as the quality of their eggs declines - and this can be quite dramatic after the age of 35.
As they get older, they start running out of eggs, because the ovary cannot produce any new eggs after birth.
This poor egg  quality comprises of two components .
Firstly, these eggs accumulate genetic defects over time. Many of these older eggs have abnormal genes, which are transmitted to the embryo, as a result of which it may arrest in the lab, or fail to implant . The problem is that we can't test for these lethal genetic defects because there are over 30000 genes in the human egg.
Equally importantly, as the eggs get older, their mitochondria - the powerhouses which drive cell division -  don't work properly anymore. As a result of this, even if the egg fertilizes , it doesn't continue to divide. Because it runs out of energy , the embryo arrests in the lab and there is no top quality blastocyst to transfer.
Sadly, these biological changes are irreversible, and while doctors have tried all kinds of interventions to "treat " these - including stem cell therapy - sadly, these "treatments" don't work !


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





Tuesday, May 28, 2019

The PGS scandal and scam


A normal baby - born after an abnormal PGS result !

This is why you should refuse to do PGS ( preimplantation genetic screening).

This new ( and very expensive !) has become very fashionable, and lots of IVF clinics are pushing their patients to do this, by claiming that it helps to improve pregnancy rates.

This is false !

All it helps to do is to improve the IVF clinic's profits - and can even reduce the patient's chances of success, because doctors end up throwing away embryos which could have become healthy babies if they had been transferred back into the uterus !

Read more at https://www.thecut.com/2017/09/ivf-abnormal-embryos-new-last-chance.html

Logic vs emotions after a failed IVF cycle



Dealing with a negative HCG after a failed IVF cycle can be extremely hard, both for the patient and the doctor. The natural tendency is to want to blame someone ! What went wrong ? Who messed up ? It's natural to want to find someone we can criticize.
The mother-in-law may criticize the patient for not taking enough bed rest - and the patient may accuse the doctor for not doing a good enough job.
This is the time when you need to be logical rather than emotional.
Yes, your heart is breaking, and you can't think straight, and this is why you may end up making a lot of irrational decisions. Under pressure, you may decide to change the clinic , or use third party options, such as donor eggs or donor sperm. You are emotionally vulnerable, and your doctor may misguide you if he is not ethical.
Take a break and give yourself some time to recover !
If the cycle went perfectly and a top quality blastocyst was transferred smoothly into an optimally prepared endometrium, then the reality is you just need to be patient and  repeat the cycle until it works. Getting frantic and changing something or doing something new out of desperation can cause harm, and you may end up reducing your chances in the long run.

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






Sunday, May 26, 2019

How many embryos should I pool ?



For many women who want to defer having children, embryo pooling is a very viable strategy . We can create embryos when they are young, and then transfer these when they are ready to start their family. This way, they don't need to worry about the impact their ticking biological clock will have on their fertility !
This option allows us to collect many embryos , freeze them, and then transfer them back one at a time after thawing them.
The question , however , is how many embryos is the right amount to pool? Is it okay if we have just two or three ? Or should we repeat the IVF cycle until we have at least four?
Obviously the more the number of embryos you have frozen, the better your chances of getting pregnant, because you will then be able to have that many more transfers , which will improve your cumulative conception rate.
However, each IVF cycle is expensive and takes time, and this can be a difficult trade off.
To a large extent, the answer depends on your risk taking appetite; the quality of your embryos; and your age . Thus, if you're getting top quality embryos and are young, then four frozen blastocysts should be enough, because it gives you an extremely good chance of getting pregnant , because you will be able to do four transfers , one blastocyst at a time.
However, if you're older, you might want to increase that number to optimize your chances of getting pregnant, because you can't reverse the biological clock !

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






Friday, May 24, 2019

The limitations of IVF and the problem with the biological clock.



 While IVF labs are great at making top-quality blastocysts, the problem is that the chance of a blastocyst from a 40 year old woman getting pregnant is less as compared to that of a 25 year old woman, even though the morphological grade and the quality of these blastocysts is identical.
This means that if we have top quality blastocysts , and one is from a 25 year old and the other is from a 40 year old, and they look exactly the same, the fact still remains that the 25 year old's top quality blastocyst has a better chance of implanting and becoming a baby as compared to the 40 year old's.
Now, this is one of the frustrations doctors have with modern reproductive medicine - we really don't have a good answer as to why this is so .
One problem is that the energy powerhouse of the eggs - the mitochondria in the cytoplasm, which drive embryo division after fertilisation - start malfunctioning as the eggs age. The problem is that we can't test for this.
Also, we know that as eggs get older, they will have more genetic errors,  as a result of which the embryos from these will also have more genetic errors, and many of these are lethal.
The problem is that we can't prevent this - and neither can we test for them , because PGS only allows us to screen for chromosomal abnormalities.
This is one of the biological limitations IVF specialists and older women need to learn to live with.

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/





Thursday, May 23, 2019

IVF clinics - quantity vs quality.



A lot of IVF clinics take pride in the large number of cycles which they do . Their focus is on their turnover, because they are profit making corporates, who need to maximise their ROI for their investors.
While is great for the management because this maximizes their revenue, it may not be good for each individual patient they treat. They use an assembly line approach, where every patient is treated as a widget, and the focus is on maximising throughput by using a "one-size-fits-all" approach.
Our focus as a boutique clinic is very different ! We make sure that we spend a lot of time and energy on each individual patient , to try to maximize their chances of getting pregnant.
What this means is that we treat each individual egg as an individual patient, and grow every follicle with love and care. Every egg is treated with respect , so that even if you have only immature eggs , we mature them in vitro , so that they can become embryos, and we can grow these to blastocysts.
The advantage of this is that we maximize each individual patient's chances of getting pregnant. Yes, this means we can't do as many cycles as a lot of very busy clinics can do, because we don't have any assistants. However, our pregnancy rates for patients are far better , because we focus so much energy on each of them.

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






Saturday, May 18, 2019

The story of an embryo !

We retrieved 4 oocyte cumlus complexes from 4 follicles for this older woman with a very low AMH level
All the 4 eggs were mature ( M2) and we did ICSI for all of them
However, only 1 fertilised
This divided well until Day 4, by which point it had formed a morule
However, the blastocyst on Day 5 was of poor quality

This photo-essay emphasises how much biological variability there is in egg and embryo quality, which is why it is so hard for us to predict the outcome of any IVF cycle 

Monday, May 13, 2019

What IVF patients need to achieve success !



When we transfer a top-quality blastocyst, patients are obviously very hopeful that they're going to get pregnant. So are doctors, because we're human beings. We want all our patients to get pregnant so that they can refer other patients to us as well.
However, when the blastocyst does not implant, this causes a lot of heartache and heartburn. 
Patients are naturally upset, and they can't understand why the cycle failed. But the reality is doctor can't understand why the cycle failed, either, because we cannot control the process of implantation. This is something we need to come to terms with.
Patients would love scientific explanations for why it didn't implant. The reality is we can't provide these. Because patients demand them, then doctors do all kinds of unnecessary additional tests, which are very profitable for the doctor to do, such as ERA and PGS, but it doesn't really help change the outcomes at all.
I remind patients sometimes all they need is a little more patience and a little bit more luck until, finally, one of the blastocysts becomes a baby.

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/







Sunday, May 12, 2019

Should you use donor eggs to have a baby ?



IVF  patients need to be very careful when making decisions , because some of these can be life changing.
If you are older and have poor ovarian reserve,  should you use donor eggs or try with your own? You need to take your time before you finalize what you want to do.
You need to listen to your head; your heart; your gut; and get second opinions before pulling the trigger. You have to explore all your options , and do a lot of soul searching, so you have peace of mind you made the right decision.
The most important thing is you need to make your own decision for yourself.
You just can't let a doctor make this for you - and neither can your husband , mother or mother-in-law ! You can listen to all their inputs, but the final call has to be yours . It's a challenging decision , and you have to take a leap of faith that you will be able to do what is right for you and for your baby .
Remember that it's your life , and you have equally difficult decisions before - after all, you are an adult !
You have the capability of making the right decision for yourself, provided you don't outsource it to anyone else , and do the deep thinking needed, so that you never have any regrets later on !

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/









Saturday, May 11, 2019

The importance of embryo grading in the IVF lab

The dirty little secret about modern IVF tests.



Most patients expect that IVF doctors will do lots of tests for them , in order to tailor their treatment so that they can maximize their chances of getting pregnant.
The problem is that a lot of the new IVF tests which are available, such as the ERA test and the PGS test do not provide the doctor with any clinically actionable information for that individual patient.
These tests are still unproven, which is why they are not done in the world's best IVF centers .
There's a lot of overlap in the results between fertile patients and infertile patients, which means you will get abnormal results in fertile patients as well.
And they really do not help us to modify the treatment cycle for the next attempt, because they don't provide us with any useful actionable information.
However, patients don't know this. They're very impressed about how thorough and careful the doctor is being - especially when they have to spend a lot of money - after all, expensive tests must be better, right ?
And doctors are happy , because they make lots of money by ordering these tests !
This is why the fact that these tests are useless for clinical application for individual patients remains a secret !
And to add insult to injury, the doctors who advice against these tests are considered to be old-fashioned and out of touch with modern trends !

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/






Friday, May 10, 2019

What we still do not know about IVF

What IVF patients need to do to make the right choices for themselves


IVF  patients need to be very careful when making decisions , because some of these can be life changing.
If you are older and have poor ovarian reserve,  should you use donor eggs or try with your own? You need to take your time before you finalize what you want to do.
You need to listen to your head; your heart; your gut; and get second opinions before pulling the trigger. You have to explore all your options , and do a lot of soul searching, so you have peace of mind you made the right decision.
The most important thing is you need to make your own decision for yourself.
You just can't let a doctor make this for you - and neither can your husband , mother or mother-in-law ! You can listen to all their inputs, but the final call has to be yours . It's a challenging decision , and you have to take a leap of faith that you will be able to do what is right for you and for your baby .
Remember that it's your life , and you have equally difficult decisions before - after all, you are an adult !
You have the capability of making the right decision for yourself, provided you don't outsource it to anyone else , and do the deep thinking needed, so that you never have any regrets later on !

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/









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Thursday, May 09, 2019

Why IVF patients should make their own choices

Why do so many IVF cycles fail?


       

Most patients who do IVF expect that the cycle is going to work. 
After all, isn't the technology great? Shouldn't they get results after spending so much money? Aren't they going to a doctor who's promising them that they have a very good chance of getting pregnant?
And surely God will be kind this time around ! After all, haven't they done everything humanly possible to have a baby ?
It's especially when the doctor shows them their top-quality blastocysts, they think that they are pregnant when these are transferred to their uterus.
But the reality is that an embryo is not a baby. Human reproduction is not efficient, because most embryos contain genetic defects which we cannot test for and which we cannot prevent.  This is the reason why most embryos do not implant, and this is why so many IVF cycles fail.
This is something which patients need to come to terms with !
I wish we had the technology to be able to overcome this problem, but that's still some time away. Till then, IVF patients need to learn to be patient !

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







Wednesday, May 08, 2019

Failed Implantation is the rule in human reproduction !




One of the most frustrating problems in IVF today is recurrent implantation failure. This is the medical terms used to describe the distressingly common scenario when top quality embryos don't become babies , cycle after cycle.
This upsets patients as well as doctors !
Doctors are very hopeful and optimistic ( as are patients) when we transfer a top quality blastocyst into a receptive endometrium, because everything seems medically perfect.
However, then the embryos stubbornly refuse to implant, the patient naturally gets upset , and starts wondering whether the doctor did something wrong - or pressurise the doctor to do something new and different the next time. Often, doctors are happy to accede to their requests, because they can charge more for doing expensive new tests, which use the latest technology, but are unproven and unreliable , because they have not stood the test of time.
Patients need to remember that implantation is still a biological black box , and that failed implantation in fact is the norm as far as human reproduction is concerned !
Don't forget that every cycle a fertile couple has sex and doesn't get pregnant, this means that the embryo has failed to implant ! ( After all, if they are fertile, this means the  sperm must be fertilising the egg in the fallopian tube, and an embryo must be being formed. However, this embryo doesn't become a baby, because human  reproduction is very inefficient. Most embryos have genetic abnormalities - whether are formed in vitro or in vivo , and this is why they don't implant .
Once you understand how common embryo implantation failure is in vivo ( in the bedroom) , you'll understand why it's so common in vitro as well.

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/






Tuesday, May 07, 2019

My interview with ETHealthworld

Shahid Akhter, the editor, ETHealthworld, spoke to Dr Aniruddha Malpani, Medical Director at Malpani IVF Clinic, Mumbai to know about IVFchallenges that still dominate and the way forward.

https://health.economictimes.indiatimes.com/news/industry/family-planning-also-means-helping-infertile-couples-to-have-babies-dr-aniruddha-malpani/69210098

What we still do not know about IVF treatment



IVF success rates have improved dramatically in the past few years,  because the technology has become progressively better.
However, one thing IVF teaches doctors very quickly is a lot of humility. This is because we still have no way of being able to predict what is going to happen to an individual egg; an individual embryo; and an individual patient.
While we know that about 40% of eggs will become blastocysts in a young woman, we cannot predict which egg will develop into a blast, and which will arrest, even though they look identical at the time of retrieval.
Similarly, we cannot predict which will blastocyst will implant; and whether or not a patient will get pregnant in that particular cycle.
This uncertainty can be frustrating - both for patients and for doctors, because patients expect definitive outcomes. They want a baby, since they have paid so much for their treatment !
Sadly, this is still something which we can provide, because the process of embryo implantation is not in our control.
All we can do is try and educate patients , so they have realistic expectations, rather than give them false hopes and lure them into signing up for treatment by making tall claims !
Well informed patients are better able to cope with the IVF emotional roller-coaster ride. More importantly , they have peace of mind that they were given top quality medical treatment, no matter what the final outcome!

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/






Why aren't young Indian professional women freezing their eggs?

Friday, May 03, 2019

Why IVF patients should make their own choices



Not all of medicine is black or white , and there are lots of gray zone areas, especially in IVF.
This is why it's so important for patients to express their preferences, and for doctors to respect these.
Thus, many IVF patients have fibroids, which are a very common finding in young fertile women as well. Now most fibroids are in the wall of the uterus, and because they don't affect fertility, good doctors are happy to leave them alone. On the other hand, there are also aggressive doctors , who want patients to have these fibroids removed, and this means patients are often confused as to what to do !
This is why they often come to us for a second and third opinion, and we try to be as non-directive as possible. We explain the pros and the cons of the surgery; explain to them what our philosophy is; and then allow them to select for themselves.
The problem is that when a doctor respectfully offers choices , patients get confused. They feel, " Why can't the doctor tell me what to do? Didn't I pay him for his opinion ? Isn't he the expert ? Isn't making a decision his job ? Does this mean the doctor's clueless because he is confused? Is he really a medical expert if he is so unsure ? After all, if he can't decide, I'm just a patient - how will I be able to decide ? "
Actually, when a doctor allow you to make a choice this means he respects you, and he's empowering you ! It's only when both  the choices are equally good ( equipoised) from a medical point of view will the doctor leave the decision upto you ! You should step up and exercise your preference , so you can do what gives you peace of mind !
Good doctors won't tell you what to do - but they won't let you make the wrong choice   either !

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/






Being infertile does not mean that you are a failure!

Thursday, May 02, 2019

The patient IVF patient !


Patience, persistence, and perseverance are extremely important for IVF patients.

Part of the problem is that everyone wants instant gratification in this day and age !

They have very unrealistic expectations of IVF success rates, partly because of all the tall claims made in misleading ads and clinic websites, which claim pregnancy rates of 60% and 70% ! These are a complete lie, but these inflated false expectations, coupled with unrealistic time frames, usually means that patients end up killing their own dreams. They go to pieces when their first IVF cycle fails, and they forget that they need to factor in the fact that IVF, like any other process, is something which takes time.

The truth is that it can take them up to three to four cycles to get pregnant, and they need to accept this before they start the IVF cycle, so they're prepared for failure , and don't go to pieces in case the first cycle does not work !


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







Why transferring one embryo at a time is the best option for IVF patients?

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