Wednesday, July 31, 2019

Why did your IVF cycle fail?

One of the problems with IVF is that most cycles will fail . When a cycle fails, the patient is never sure whether the failure was because of a basic biological problem which they have, or whether it was because the doctor was incompetent .
They aren't sure if their chances would increase if they changed the doctor , and aren't sure if they should switch, or continue with the same clinic, with whom they have a relationship, and who knows their medical details.
This is why it's so important that patients demand that IVF clinics provide them with photos of their embryos routinely.
The right time to ask for this is before you've paid your fees - before you start your IVF cycle. The truth is that once you've started, there's going to be precious little you can do about their refusal to give you photos of your own embryos
I still don't understand why all IVF clinics aren't willing to share such basic information routinely. 
After all, the one thing an IVF clinic does is make embryos, and a good IVF clinic will proactively share photos , to document the fact that they have provided good quality treatment.
If your clinic refuses to do this, you should definitely worry , because this means they're not confident about the quality of care they're providing you with !

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

Tuesday, July 30, 2019

Is your doctor a good IVF doctor?

The problem is that it's very hard for patients to answer this question because all doctors look pretty much the same.
They all seem to have the same fancy degrees; posh clinics; and lots of patients.
And because they advertise so heavily, it's very hard for patients to differentiate one from the other. Since it's difficult for patients to judge technical competence, they are forced to rely on the doctor's bedside manner. The problem is that the senior doctor is in " sell mode " during the first visit, and is doing his best to get you to sign up.
The trouble is that you aren't going to see the same doctor again when you actually start your treatment ! This will get delegated to juniors and assistants, most of whom are clueless and inexperienced.
This is why you need to ask just one simple question before you start your IVF cycle !
"Do you provide photos of the embryos to all your patients routinely?"
And if a clinic doesn't do that, that means something's wrong ! After all, the only thing an IVF clinic can do is make embryos , and good clinic provide photos routinely which patients can see for themselves , so that they know that they have received good quality treatment !

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

Monday, July 22, 2019

Why I froze my eggs

This is a guest post from one of our patients. She is 32 and recently froze her eggs at Malpani Infertility Clinic

Our 20’s and early 30's may be the easiest time to have a baby but it's not always the best time - for a lot of good reasons. We are at the top of our career and want to grow professionally; we want to prepare emotionally and financially to be parents ; and we are unwilling to settle for Mr. RightNow instead of Mr. Right.

The problem is that the biological clock is ticking on - and we can hear it loud and clear ! The good news is that with a little medical help , we can freeze time , to plan for the future , and create a safety net for our eggs !

Egg Freezing gives us the opportunity to take control of a ‘What if’ situation and preserve our fertility until we are ready to have a baby.

I recently took the path less traveled and froze my eggs. Here are some key takeaways from from my journey:

Find the best doctor for you

With the number of IVF clinics burgeoning around the country; I cannot emphasise enough the importance of a finding a great doctor. It is a super specialised procedure and can be tricky and emotional. It is also expensive. So the last thing you want is a doctor who is unequipped in any way or one that doesn’t have your best interest at heart.

I was incredibly lucky to find Mumbai based, Dr. Anjali and Dr. Aniruddha Malpani who are pioneers the field. Their vast knowledge and infinite experience, state of the art medical facilities, generosity and patience with educating their patients, honesty and genuine compassion in discussing the realistic possibilities truly left me feeling like I was in the best hands possible.

The initial tests are important

After your first consultation; your doctor will advise you a series of tests to evaluate your reproductive health , to check your ovarian reserve.  This is a simple blood test to check your AMH level; and a vaginal ultrasound scan to check your antral follicle count.
It's best to not make any assumptions at this stage with respect to what your fertility prospects are. Whatever the outcome of these results; it's important to remain objective and not feel guilty or stressed and to work with your doctor to find the best way forward. 

The procedure

You will need to take injections for about 10-12 days , to mature your eggs, so they are ready for collection. I know the idea of taking shots daily can put anyone off, but these are given subcutaneously, through a very fine needle, which means they aren't painful, and you can learn to take them yourself.

The egg retrieval process (in a nutshell)

The doctor will do scans about 3-4 times during this process, to make sure your eggs are growing well. When they are mature, the eggs are ready to be retrieved. This takes less than 30 mins, and is done under anesthesia, so there is no pain. Hospitalisation is not needed, because it's done under vaginal ultrasound guidance, so there's no surgery involved.

Recovery times will vary. In my case I was working full time throughout the process and was back on my feet an hour after surgery.

You may need more than one cycle

In general doctors advise that you freeze about 10 eggs , so you have a good chance of getting pregnant when you want to have a baby. How many mature eggs the doctor will be able to freeze for you varies from person to person. But what’s important to note is that you may need more than one cycle to freeze sufficient number of eggs.

Seek positive affirmation and support

When I mentioned to my mum and my closest friends that I was thinking about having my eggs frozen, their response was ‘That’s a great idea!’.

But don’t expect everyone to understand your decision. Be prepared to not have unanimous support and even receive unwelcome advice from those who do not understand you. The journey can be emotional and despite your best efforts to stay strong and independent, having a support system will help you remain positive throughout the process.

Plan Financially

Unless you work for a progressive company like Google that provides IVF benefits, you must factor in the cost of having your eggs frozen. As you can now appreciate, the treatment is super specialised and expensive. It's a good idea to discuss the full cost of the treatment upfront with your doctor and then evaluate your current status or work with your insurance provider to confirm what costs are covered.

What next ?

When I am ready to start a family, I hope to conceive naturally, so that I don't need to use my frozen eggs . I am just creating a safety net for myself right now.

Also, I understand that having my eggs frozen does not guarantee having a baby , but it hugely reduces the risks of my never having a baby. This has left me feeling empowered, in control of my future and frankly, a bit relieved.

I also feel oddly proud that I was able to silence the voices - both inside my head and socially , and be brave enough to take this step, reaffirming that I am the modern, forward thinking woman that I think myself of as being , and have always striven to be.

I share my journey in the hope to alleviate the social stigma around preserving fertility and to extend my whole hearted support to those who have been thinking about egg freezing , but feel too embarrassed, ashamed, scared or alone to do this for whatever reason.

Not leaving your fertility to destiny is a smart thing to do.

Sunday, July 21, 2019

Making sense of your HCG levels

When IVF patients get pregnant, they know how important measuring their blood  HCG level is, to monitor the health of their pregnancy.

However , they aren't sure how to interpret these levels.

The reason it can be hard to make sense of them is because the normal range varies vary so widely; and because they rise so quickly as the pregnancy grows.

Remember that HCG levels are very dependent on the gestational age of the pregnancy.

Also, tracking HCG levels over time gives us far more valuable information as compared to just a single level !


You can register at so you can track and monitor your pregnancy

Or you can email me for help at [email protected] !

What to find an IVF clinic which respects your time and intelligence ?
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Saturday, July 20, 2019

Cancelling the IVF cycle because of a poor ovarian response

IVF patients who have a poor ovarian response are often not sure what to do. 
When they grow very few follicles inspite of taking lots of injections, they are understandably depressed and upset. Few follicles = few  eggs = few embryos, which means their chances of success are not very bright.
One option is to cancel the cycle. However, the problem with this is that it's very unlikely that the next cycle will be any better , because poor ovarian response is often biologically determined. 
And unless they've gone to a clinic which is bad,  or if they feel that their doctor was incompetent and did not do a good job with superovulating them, then this is a biological constraint they need to learn to live with.
Often a bird in the hand is worth two in the bush, and if it's going to give you peace of mind that you gave it your best shot, it's better to go on with the cycle , even if the response is poor, rather than to stop halfway. This is especially true if your AMH and AFC are low, or if you have had a poor response in an earlier IVF cycle as well

What to find an IVF clinic which respects your time and intelligence ?
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Sunday, July 14, 2019

IVF packages and how to make sense of them !

Lots of clinics offer IVF packages these days, and these are helpful because not all patients will get pregnant in their first IVF cycle. Signing up for a package which offers 3 cycles ensures that they have realistic expectations of IVF treatment, and that they understand that it may take time for them to be successful. They start thinking about their cumulative pregnancy rate over two or three cycles , rather than think of IVF as a single shot affair.
The problem is that a lot of clinic which offer these IVF packages hide a lot of fine print in them. This misleads patients, because the clinic does not include the cost of basics such as medications or tests.
Even worse, they will offer "add-on" medications at an extra cost, by up-selling  them as being more "effective". This is why patients need to be very careful when signing up for these packages.
Some of the best IVF packages are the shared risk ones. These offer to refund the money if the patient fails to get pregnant, and are extremely popular in the US , because this aligns the interests for the clinic and the patient.
It gives the patient a lot of comfort , because a safety net has been created, and allows them to put a cap on their expenses. This is a progressive measure, which needs to be encouraged in India as well !

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

Tuesday, July 09, 2019

How can we make IVF kinder

Most IVF patients are understandably petrified about an IVF cycle , because of the high dose of hormonal injections which they need to take every day. Not only are they worried about the side effects, this also adds to their expense considerably !

This is why we've developed a kinder method of doing IVF , which requires a much lower dose of injections.

This is called natural cycle IVF or minimal stimulation IVF, and treatment takes only a few days !


This makes it much more affordable , and the side effects are less as well. Interestingly, even though the follicles are fewer, these are usually the best quality follicles , which means we get good quality eggs , and good quality embryos as well, which means pregnancy rates remain high.

This is an option which is well worth considering , especially if you have had a poor ovarian response in spite of taking a high dose of injections, or find that you can't afford to spend so much on the hormonal injections.

What to find an IVF clinic which respects your time and intelligence ?
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Sunday, July 07, 2019

Flying to Malpani Clinic for IVF treatment

At the end of last year, Ekaterina Aleksandrova boarded a plane in London and flew to Mumbai. It wasn't her first trip there - she is a management consultant and often goes abroad on business. But this time she went to have embryos transferred in her womb. A couple of days later she flew back to Europe. While on business in Hong Kong in January, she discovered she was pregnant with just one embryo.
For Aleksandrova, 42, this was the culmination of a six-year struggle to become a mother. She divorced at 29, and hadn't been in a serious relationship since she was 34. "I always wanted to have a child but the men kept saying, 'Why don't we travel?'" she says. "It wasn't that I was obsessed with my career, I just couldn't get men to be a father."

Monday, July 01, 2019

An IVF success story at Malpani Infertility Clinic

Our story.... to begin no different from many infertile couples. A perfect love marriage in 2005 with everyone's blessing after 5 years of courtship! As we began this exciting journey of togetherness, at age of 23, conscious decision was made not to start a family until be both settle well in careers, have a house of our own and descent earning to support a good standard of living. Years passed by fast and we were all set by 2009 to begin 'trying' for a baby with a confidence to be conceiving soon.....
2010 came, with no success after trying for almost a year. The doctor in me alerted my own self that something is not going right. Went to seek a gynaec opinion and was taken aback to learn that I had PCOS (polycystic ovaries) with anovulatory cycles which needs to be treated before we could try again. 6 months of treatment and the cycles were responding well. 
Started off with my ovulations studies and trying 'normally' for 6-8 months. Again no luck! Meanwhile, during this process, further good news for me was to learn that I am a thalessemia minor (a type of anemia) and grade 1 heart disease - MVP.  And being a medic, I knew what this meant for me - conceiving will be a challenge and pregnancy will be high-risk.
So I was referred to the so called experts in infertility in the town (Pune).  Hysteroscopy confirmed everything normal and IUI suggested. 5 failed IUI cycles left us with 'IVF' thrown as the last option to conceive. By this time, all possible pujas, stone wearing and offerings  at temples began under parental guidance with us resorting to it due to the insecurity of the creepy thought,  ' What if we don't conceive' !!
Started the first IVF along with 40 other patients at an IVF center in Pune (literally felt like visiting a baby making factory), and after goggling all the positive IVF stories and being inspired by them, we began the journey of innumerable pricks both physically and emotionally (this part was far more painful).
On the day of pick-up the center expert comes and informs me that the process cannot go ahead as my eggs were poor quality and I will need to go for egg donation as she feels I would not be able to produce viable eggs. Shattered with the failure and top of it the daunting words of the center head rather than being encouraging - were the perfect recipe for going into depression.
I gathered myself next day and went through the literature and reassured myself that 'I must not loose hope'. We waited for 6 months and repeated another IVF with the same center (because we had paid for a combo deal !!!). This time the so called 'supposedly bad quality' eggs managed to go to the level of ET and then the killing 2 weeks wait....just to see a negative result !
We lost all hopes, less because of failure and more because of the 'business minded' IVF centers all around, interested just in mending money without any humanitarian approach or sympathy toward their patients.worst part is that they follow 'one shoe fits all' approach with their treatment.  For them, patients were clients and IVF was just a business. We decided not to go ahead with any more IVF tortures and take a brake mentally from all this and think on the lines of adoption later.
Dec 2013, I met another doctor colleague of mine and was discussing this experience with him.  He took out his 1 year old daughter's picture on mobile  and showed it to me. I just kept looking at her twinkling eyes and innocent smile and said - Oh what a cute baby! He then informed me about their experience with Dr. Malpani from Mumbai and how they succeeded in their first attempt to have this cute angel in their life.
What really struck me was, my friend's comment - 'You won't feel cheated even if the procedure is a failure, just go and meet him once'. After a week of hesitancy to go through it all again, I checked their website which was pretty impressive in terms of the 'effort' taken to 'explain' the science of IVF to a common man. Their section on 'knowledge center' and IVF comic were a brilliant form of patient engagement in educating them on the various aspects of IVF. 
I picked up my laptop and wrote an explanatory email to Dr. Malpani with my case details.  Got busy with my daily routine thinking he will reply in some days.  I was pleasantly shocked to see his detailed email the same evening with some great suggestions with no urge to come and meet him for a consultation (like what you experience with a lot of hospital into e marketing) .
After this we kept discussing on email for next 4-5 months before we went to meet him personally in June 2014.  We went there with a very open mind and absolutely no expectations.
The clinic was very atypical of hospital/fertility centers and had a very positive environment.  The staff was  extremely courteous  and empathetic.  While we were waiting for Dr. Malpani to arrive, we were just glancing through the  feedback book and what caught our attention was a feedback from someone who could not succeed with the IVF.
He had written a lot of good things about the Malpani couple and the clinic and expressed a desire to come back again when they think of taking a chance again. And then came our turn for consultation. The best part of Dr. Malpani's consultation was his frank advice - Have your plan A, B and C ready. Success is not guaranteed.  People make a mistake of investing their entire money and emotions into the IVF thinking this is a guaranteed success. 
And that's where we probably went wrong in the first 2 attempts. He did a detailed study of my reports and informed us beforehand that the treatment followed will be different than others and will be twice expensive as I have very low AMH counts (lesser number of eggs than normal females) and wrote us a list of medicines to be taken in case we plan to go ahead with his treatment. We felt relieved that someone is ready to understand us as a patient and tailor make the treatment to get the best  results out of us. At least there was an intention to do the best possible and see success with my eggs, by Dr. Malpani, unlike the previous clinic experience.
I walked out of the clinic with a  'HOPE', huge peace and a firm belief that 'He (Dr. Malpani) can surely get the best eggs out of me'. Sounds funny, but after having thought of only eggs and sperms and their quality, failure etc for 4-5 years, you literally start considering yourself a rooster in a poultry farm, producing eggs every cycle !!! haha....
August 1st 2014 we began the IVF with Dr. Malpani.  We used to travel Pune to Mumbai daily on the day of visits. The entire treatment period was a roller coaster ride with my body responding differently at every visit. Finally came the day of 'pick-up' when Dr. Mrs. Malpani informed me with a sweet smile as I woke up from anesthesia that I have produced 11 good eggs !!! 
On the day of ET,  Dr. Malpani did the procedure with a great positivity in the OT and asked us to hold hands and remember our prayers while he transferred the embryos. After the procedure I asked him the commonest query, do I need to be on bed rest? And he smiled at me and said. 'the embryos do not fall out, so just chill and both of you spend some good time for next 2-3 days'.  We did follow his advice seriously !
The next 2 weeks wait was a killing experience, but we were sure to have a next cycle repeated after 2 months with Dr. Malpani again, if this fails.  And the MOST pleasant surprise of my life was, a positive Beta HCG test received on my email at 6.25 pm on 25th Aug 2014. Our HOPE had finally converted into a 'LIFE'. It left eyes wet, hearts overwhelmed with joy and soul filled with gratitude for the Dr. Malpani and his entire staff.
The journey of pregnancy was a great experience and Dr. Malpani was always there to address any advice we would seek.  Today I hold my 4 months old daughter in my arms...spending endless hours admiring and kissing those little feet, hands and forehead....and thanking God for routing us to the blessed hands of Dr. Malpani.
If God has chosen me to experience the joys of motherhood again, and if it has to be an assisted reproduction,  Dr. Malpani Clinic is the only choice we would have in mind !

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

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