Wednesday, September 18, 2019

Can you trust your IVF doctor? IVF video

Egg Plus Sperm = Baby - The reproductive equation

When a woman gets pregnant in her bedroom, the reproductive equation is very simple.
She ovulates a single egg from a mature follicle in her ovary , which gets fertilized by a single sperm, which forms a single embryo, which then becomes a baby.
So the equation is : follicle -> egg + sperm = embryo -> baby.
Of course, natural reproductive efficiency is not great, and fecundity for a young fertile woman is only about 20%, in one cycle.
This means that most women will not get pregnant in most cycles, even though she has sex regularly. Now this means that the equation breaks down - either because she did not grow a follicle                    ( anovulation); or didn't release an egg ; or the sperm didn't manage to fertilize the egg ; or the embryo didn't implant.
Often, for fertile women, it's the failure of embryo implantation which is the reason they don't get pregnant every month they have sex. This is the weak link in the reproductive equation, and is because most embryos have genetic defects - whether these are created in vivo, or in vitro !
IVF patients need to remember that a follicle is not equal to an egg; and egg is not equal to an embryo; and an embryo is not equal to a baby ! Yes, we can help them to grow follicles, but these don't always translate into babies, because of human biological reproductive inefficiency.  Many follicles don't contain eggs; many eggs don't fertilise; and most embryos don't implant.

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

Tuesday, September 17, 2019

आय.व्ही.एफ. प्रक्रियेच्या 7 सोप्या चरण. IVF Video Marathi

Using K Y jelly reduces your fertility ! IVF video

Ovarian cyst vs follicle

Lots of patients are unsure about the difference between an ovarian cyst and a follicle.
The reality is that as far as an ultrasound scan is concerned, they both look exactly the same - they both appear like black bubbles.
The only differentiation is based on their size, which means  if it's large, we call it a cyst, and if it's small, we call it a follicle.
Now, the arbitrary size cutoff is 20- 25 mm, which means many patients think that a follicle should be 25 millimeters or less. The reality , however, is that there is a lot of overlap, and large follicles look exactly like small cysts do.
On a single scan, it's impossible to differentiate between the two, which is why serial ultrasound scans are so helpful . Follicles usually grow at 1-2 mm per day, and while cysts can grow as well, they are usually remain the same size over a few days
However, the final proof of the pudding is in the eating. When we do IVF and stick a needle in the follicle,  and get an egg, we call it a follicle. If we don't get an egg, we call it a cyst ! But we'll only know at the time of the egg collection whether this was a cyst or a follicle .

Monday, September 16, 2019

The effect of an IVF cycle on the husband.

Whenever we talk about IVF cycles, our focus is usually on the woman. This is understandable , because she's the one who has to take the injections, go for the scans, undergo the egg collection and embryo transfer process, and live through the 2 week wait. 
And all the husband needs to do is to give a semen sample !
However, the reality is that the husband also suffers a lot of heartbreak and pain.
This is especially acute when the reason for the infertility is a problem with his sperm. He feels very guilty that his wife is having to go through all the pain of an IVF cycle this because he's not able to get her pregnant in the bedroom.
This makes him feel inadequate and incompetent; diminishes his self-esteem; affects his sexual desire ; and even cause situational erectile dysfunction , because he feels that he cannot even perform a simple role which every other man in the world seems to be able to do without any difficulty at all - including all the beggars on the street !
He goes through an emotional rollercoaster ride as well, but it's much harder for him to express his feelings , because he's a man and he's supposed to bottle his emotions up.
And he's not sure whether he can share them safely with his wife or not, because he is worried that this will just add to her burden, which means he does not have a shoulder to cry on , and has to grieve alone.
You can read more about why infertile men get such poor treatment at
What to find an IVF clinic which respects your time and intelligence ?

व्यस्त आईवीएफ़ क्लीनिक्स या अच्छे आईवीएफ़ क्लीनिक्स - Hindi IVF video

Saturday, September 14, 2019

The grieving process after a failed IVF cycle

IVF failure causes a lot of heartbreak, and part of the problem is patients don't process the grief efficiently. This makes a bad problem even worse !
Some  pretend that it's not a big deal, and that they are coping well. They believe they will be able to bounce back, and put on a brave front.
This is especially true for the husband, because the fact is that  his heart is breaking too when the cycle doesn't work. He hates having to see his wife go through all that trauma - the pain of the injections  and her disappointment when the result is negative. It's very hard for him to see her suffer, but he can't display his emotions , because that'll cause her to break down. This is why grief and sorrow remains the elephant in the room, and because it's not addressed proactively and head-on, it festers, because they both pretend that everything is fine.
If you can manage to deal with the heartbreak because you are strong and can bounce back, that's fine. If you're able to process it yourself, great. If not, please find a loved one -, a family member, or your spouse , who can give you a shoulder to cry on . It's also a good idea to look for a counselor, who can help you deal with this, because they are mental health professionals.
If you can process the grieving phase in a healthy fashion,  this will help you become much more resilient !

What to find an IVF clinic which respects your time and intelligence ?
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Tuesday, September 10, 2019

IVF video - The IVF patient's fears!

IVF patients carry a lot of emotional baggage

They already suffer from  low self esteem , because they can't even do something as simple as making a baby in the bedroom - a biological process which millions of women can do without any effort whatsoever , and have been doing successfully without any help for centuries.
This lack of confidence spills over into their professional life, and starts affecting sexual desires as well. Infertility has social consequences as well, because friends either sympathize with them , and outsiders look down on them, which makes coping even harder.
The problem gets exacerbated when they do an IVF cycle and it fails. The confidence which they had in IVF doctors takes a beating, and they start believing they will never ever be able to have a baby, because they have failed to get pregnant even after taking the  most effective treatment available.
The problem with IVF is that doctors tend to overpromise, especially because they want the patient to do their first cycle with them. When the cycle fails, they often abandon the patient, because they have already extracted their professional fees. Patients feel cheated , and believe they didn't get a fair deal. They are often treated badly, because the clinic refuses to share medical details or provide a clear explanation, and this colors their perception of other IVF doctors as well.
Many of them refuse to ever try another IVF cycle again - an attitude which causes them the most harm, because not all IVF doctors are the same, and they deprive themselves of trying treatment which gives them their best chances of having a baby !

What to find an IVF clinic which respects your time and intelligence ?
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Monday, September 09, 2019

IVF video - The problem with bad IVF clinics

Learning from every IVF cycle

The outcome of an IVF cycle can never be predicted, and sometimes in spite of the best possible medical treatment, your cycle may fail.

The important thing is not so much the failure, as to what we can learn from the failure, which is why our focus should never be on just the outcome - it should be on the process !
Was the treatment done properly or not? Was information shared with you? Did each stage in the treatment go properly? What are the tangible endpoints which you can check for? Was your ovarian response fine? Was your endometrium thick and trilaminar on the ultrasound scans? Did you get lots of good quality eggs? What was the embryo quality? Did the doctor transfer top quality blastocysts  ?
Does this seem confusing ? It shouldn't be, because the basics are quite simple !
Here's a simple hack - the single key  question you should be asking.

Do you have photographs of the embryos the doctor transferred, so you can check that these were top quality blastocysts ?
 As long as you ( and your doctor !) learn from each IVF failure, you will keep on making progress , until you finally get pregnant.
The secret for IVF success is to keep on doing it , until it finally works.

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

Sunday, September 08, 2019

Why azoospermic men get poor quality treatment

One of the reason azoospermic men don't get good quality treatment in IVF clinics is because most IVF clinics don't have a full-time urologist / andrologist on their staff.
This means they have to depend on an external consultant urologist to come and do the surgical procedures for sperm retrieval, such as PESA or a TESA. The problem is that often these andrologists are extremely busy , because they're traveling all over the place, which means they're often not available to do the procedure on the day of the egg pickup.

This obviously affects the chances of the patient getting pregnant , because the clinic is then forced to depend on using frozen testicular sperm or frozen epididymal sperm or the IVF/ICSI treatment.
The success rates of using frozen testicular and epididymal sperm is not as good, because it's hard to judge sperm viability after the thaw.
This means the poor patient's chance of getting pregnant drops considerably.

If you need surgical sperm retrieval for your IVF/ICSI treatment, you should make sure that the IVF clinic you go to has a full-time andrologist , who's able to do the PESA/TESA on the day of egg collection, so that the embryologist has fresh testicular/ epididymal sperm to work with !
What to find an IVF clinic which respects your time and intelligence ?

Saturday, September 07, 2019

The IVF patient's fears

One of the biggest fears which IVF patients have when they go to an IVF clinic is that the doctor will advise them to do IVF , whether they actually need it or not !
This is a valid concern , because IVF is a much more expensive treatment than the alternatives.
If there are simpler, less expensive treatments available ( such as IUI), then these could actually help the patients to get pregnant in a far more cost-effective manner.
The patient's unexpressed fear is that the IVF doctor may want to maximize his income , and may not discuss simpler, cheaper options with them.
This is why it's so important that patients be well-informed. They need to do their homework, so they have a chance to think through all their options.
A good IVF doctor will always explain alternatives to you, starting all the way from nonmedical options such as adoption, all the way to simpler treatment options. He will discuss the pros and cons of each , rather than try to force you to do IVF just because he happens to be an IVF clinic.
That's the advantage of going to an experienced doctor, who is not practising medicine just to make money !

What to find an IVF clinic which respects your time and intelligence ?
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Friday, September 06, 2019

IVF video - what's the commonest mistake IVF patients make ?

Can you trust your IVF doctor?

Trust is an integral part of a doctor patient relationship, and it helps to improve your chances of    IVF success ! If you respect and trust your doctor , and he respects and trusts you, you will be able to work together to achieve your goal.
The trouble is that much of IVF medicine has become commercialized today .
It's hard for doctors to be able to create that trust, and patients are pretty much forced to do whatever they're told to do.
There isn't enough time for them to sit down and talk to the doctor, and they often feel short-changed and cheated when things don't go well.
This is why it's so important that IVF doctors learn to be open and transparent !
This is the best way of letting patients know that they are reliable and honest. By sharing information with patients and documenting it, they are signalling they are competent and caring.
This is why it's so important that patients ask the IVF doctor for photos of their embryos during the IVF cycle. This helps to keep everyone honest !

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

Thursday, September 05, 2019

The problems which bad IVF clinics cause.

In an ideal world, all IVF clinics would be equally good.
They would have high quality control standards; would be open and transparent; follow global best practices; respect their patients;  and share medical records routinely and proactively with their patients , so that whether or not patients got pregnant, they would have peace of mind that they have received good quality treatment.
Tragically, this just does not happen in India today , and sadly the government hasn't done a good job with regulating IVF clinics.
This means the quality can be extremely patchy, and while we do have some world class IVF clinics, we have some terrible ones as well.
This is why it's so important that patients be proactive and learn to figure out the difference between a good and a bad IVF clinic.
The good news is it's easy to do so , because all you need to do is demand photos of your embryos.. The bad news is that bad IVF clinics refuse to share these, and thus end up damaging the reputation of the entire IVF profession, because patients get upset when the doctor hides information from them.
And once patients have burned their fingers with one IVF clinic, they're very reluctant to go to a second one , because they think all IVF clinics are equally bad, and will cheat them.

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

Wednesday, September 04, 2019

But you do not need IVF !

Many patients who come to us for a second opinion have been advised IVF by other IVF specialists , and they want to find out if we can do a better job.
When I review their records, I sometimes tell them - You don't need IVF at all !
They get perplexed , because mentally they were all prepared to start an IVF cycle. And after all, I am an IVF specialist, so shouldn't I be doing IVF for them.
The reason they came to me was just to decide if they wanted to do it in our clinic, or with their local IVF doctor.
Now, when I tell them that they don't need IVF at all, this comes as a bit of a surprise to them , and they're not mentally prepared to accept this good news.
The fact is that lots of patients who are advised to do IVF don't actually need IVF at all .
They often have simple problems, which could be resolved with simpler treatment options, such as IUI .
Also, many of them have been pushed into going in for IVF, because their doctor found an isolated abnormality ( such as a low AMH level or a thin uterine lining), and advised them that IVF would be their best option.
However, this is not the right advice for many women, and we try to explain this to them. While some are relieved that they don't need IVF, others aren't convinced, in which case we tell them to find another IVF clinic for their treatment, because we will not do IVF for patients who we think don't need this !
Want to find an honest IVF clinic which will not take you for a ride ?

Tuesday, September 03, 2019

IVF as a game of chance. IVF video

Reinventing the IVF consultation

Traditional clinical practice was based on the fact that the doctor would see the patient in the clinic; take a history; do an examination; run some tests; and then offer a treatment plan. This is the consultations have been done for years.
However, times are changing, and we need to reinvent the consultation format. This is especially true for infertility and IVF treatment, because the treatment plan is usually based on lab results.
For most infertile couples, a lot of the fertility tests have already been performed, and this is what the doctor needs to review. This is much more efficiently done digitally by email, rather than a face to face consultation.
For one thing, the patient saves money, because he doesn't need to travel;  or wait to get an appointment. It's also much quicker, because he doesn't need to make a trip to the clinic.
Also, because the doctor can examine all the scans and test results , he can provide a well thought out opinion, and share this in writing ( which is legible, as compared to his hand-written scrawl  on the consultation sheet in the clinic !)
Finally, because he needs to document this, he is careful and applies his mind thoughtfully. And  because this is documented, his opinion can be shared with friends, family members, and other doctors.
This is why digital second opinions are so much better , and help you confirm you are on the right track !
Please send me your medical details by filling in the form at so that I can help you to have a baby !

Monday, September 02, 2019

Timing " baby making sex " reduces your fertility !

One of the commonest mistakes which infertile couples commit is that they reduce their own fertility by trying to time intercourse.
The standard medical advice given to men is that they should not have sex for two or three days prior to ovulation , so they can " store up " their sperm . They are told that If they then ejaculate after 3 days of abstinence, their chances of getting pregnant with this higher sperm count increases.
This seems to make a lot of intuitive sense. If you want to run a 100 meter sprint, you know you should rest before you start. Also, every man can vouch from personal experience that the volume of the ejaculate increases if you abstain from sex.
However, this is poor quality advice. If you don't ejaculate for a long time, it's only the number of dead sperms which increase - the number of actively motile sperms don't !
The truth is that the more frequently you have sex - the more often you ejaculate- the higher will be the number of actively motile sperms in the semen sample ( even though the volume of the ejaculate will decrease) .
So if you want to maximise your fertility, please throw away your ovulation apps , your OPKs and your fertility calculators ! Just make sure that you have intercourse frequently  and please don't try to schedule intercourse.  This just creates all kinds of problems, because it leads to quarrels, and converts a pleasurable bedroom activity into a clinical chore !
The secret is to have sex as frequently as possible - and this is a fun prescription, so you should be even happier !

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