Saturday, September 28, 2019

How do you calculate how many weeks pregnant you are after IVF ?



Lots of IVF patients who get pregnant are confused when they calculate their due date after an IVF treatment.
And it's not just confusing for patients - it's confusing for family physicians , as well as some gynecologists.
The reason for the confusion is because when obstetricians date a pregnancy, they talk in terms of gestational age. In clinical practice, this refers to the menstrual age, and not the embryonic age. This makes sense, because most pregnant women know their last menstrual period ( LMP), but not the day they ovulated and got pregnant.
This means that when fertile women miss their period find out they are pregnant in the normal course of events, they are already considered to be four weeks pregnant. Now, biologically, this makes no sense , ovulation and embryos  implantation could only have occurred 14 days after the last menstrual period ! This means that even though the  embryo's age is only 14 days or two weeks ( as calculated from the date of ovulation, or DPO = day post ovulation) , in clinical practise , the woman is considered to be four weeks pregnant.
There's always this two week lag between the embryo's age and the clinical gestations age, when we date a pregnancy.
You need to keep this in mind when you're calculating your due date after IVF.

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







Friday, September 27, 2019

Timing " baby making sex " reduces your fertility !

What happens after the embryo transfer ?



The two week wait ( 2ww) after an embryo transfer can be an extremely stressful time, because in one sense you're partially pregnant.
This might seem to make no logical sense, but because you know the doctor has transferred an embryo in your uterus,  in one sense you are pregnant, but on the other hand , implantation has still not occurred. In one sense, you are in a no woman's land , and you're never sure what you can do to increase the chances of the embryo implanting.
The biggest fear is that if you do something wrong , the embryo will fail to implant.
The reality is there's nothing much which you or your doctor can do during this waiting period.
You just have to take the medications which the doctor prescribes - estrogen and progesterone , to provide luteal phase support.
But beyond this, there is no special precaution you need to take. There's absolutely no need for bedrest or dietary precautions.
You should lead a normal life , because your embryo is safe in your uterus, like a pearl in an oyster.
Whether it's going to implant or not is not something anyone can predict or control or do anything about !

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







Thursday, September 26, 2019

How to find an IVF clinic which cares about you - IVF video

Why doesn't every perfect IVF cycle end up in a pregnancy?



Often patients have a medically perfect embryo transfer when they do an IVF cycle. The embryo is a top quality blastocyst, the endometrium is 8 mm and trilaminar and the embryo transfer was technically smooth.
When patients hear that everything went perfectly, they are obviously very optimistic , and are very sure that they're going to get pregnant.

However, when the cycle fails, they can't understand what went wrong.
And that's the first question they ask, "What went wrong? Did I do something wrong? Was I too anxious? Didn't I rest enough? Didn't I take enough medications?"
There is often quite a bit of blaming the victim - and it's often the relatives who do this. And sadly, sometimes the doctor becomes the scapegoat , because everyone says the doctor must have messed up if the cycle failed.

The reality is that there are 3 things which we can measure in an IVF cycle, and these three tangibles are the embryo; the endometrium ; and the ease of the transfer.
However, there are still lots of things which we can't control or measure - for example, the genetic makeup of the embryo, and it is these genetic abnormalities which cause embryo implantation failure.
This is why IVF patients need patience and persistence to succeed  - and the good news is that the reward is well worth it  !

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




Wednesday, September 25, 2019

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

IVF video - How IVF patients can reduce their anxiety and fears about IVF

When does the embryo implant after the embryo transfer ?



There's still a lot of mystery around the IVF process, partly because most people weren't paying too much attention in the human reproductive biology class in the 10th grade !
A common question I'm asked is - how long after embryo transfer does implantation occur?
While the answer depends on whether it's a Day 3 transfer or a Day 5 transfer, the reality is that implantation is a continual process. There's no magic Cinderella time which occurs so many hours after the transfer, which is special , or which determines the outcome.
Remember that implantation is an intricate biological dance between the embryo and the endometrium, which involves a process which takes over a week . This includes apposition, adhesion, as well as invasion.
All of these have to go like clockwork for an embryo to implant, and it's a miracle that it happens so frequently and uneventfully in the bedroom for fertile couples so routinely !

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






Tuesday, September 24, 2019

IVF video - Analysing a failed IVF cycle

Does IVF increase the risk of miscarriages ?



Lots of people are worried that IVF treatment will increase the risk of miscarriage. After all, you're fiddling around with eggs, sperms, and embryos in the laboratory, and isn't this artificial? And won't this increase the chance of the embryo being rejected?
However, the truth is that IVF does not increase the risk of miscarriage, because we're just mimicking the natural in vivo process. The only differences is, instead of doing it in the fallopian tube, we're doing it in the test tube.
But IVF doesn't reduce the risk of miscarriage either - it remains 15%, just like it does in the general population, where we know that 15% of all pregnancies will miscarry.
In fact the background risk of a miscarriage in IVF patients is higher as compared to the general population because these couples are older, which means, even if they had got pregnant in the bedroom, their risk of miscarriage would be higher , as compared to a young, fertile couple.
The problem is that if you miscarry after doing IVF treatment, it's much harder to take this miscarriage in your stride , because it has a much greater emotional impact in IVF patients. Even worse, both patients and their relatives will always blame the IVF process for the miscarriage !

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






Monday, September 23, 2019

IVF video - The emotional baggage which IVF patients carry

The problem with IVF doctor referral sites



One of the biggest quandaries a patient faces is how to find the right IVF doctor.
Can you trust this doctor? Is he good? Is he competent? Will he treat you well ?
This is why doctor referral sites have become extremely popular, and the market leader is Practo. However, there are lots of new ones for IVF clinics as well. They advertise aggressively on Google, in order to score high on the search results.
The problem is that their business model is completely messed up , because they aren't putting the patient's interests first. They are VC-funded, which means their interest is to maximize their revenue. They way they do this is to make as much money as possible from the referral.
This is why they aggregate the name of many clinics and doctors on their platform, and will charge clinics for a preferred listing. This means that the  clinics which are willing to pay the most will get featured the most prominently , and will make the most money. This is sad, because these are the same clinics who are out to maximise their revenue. They want a ROI on their ad spend, which is why they put profits before patients ! The good doctors don't feel the need to advertise, which means they rank much lower down, even though they may be much better !

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






Sunday, September 22, 2019

After failed IVF, can I get pregnant naturally?



Patients do IVF with a lot of hope, because  they know this is the one method which maximizes their chances of getting pregnant. They pin all their hopes on the IVF cycle, but when the IVF cycle fails, they are completely heartbroken , and worry about whether they'll ever be able to get pregnant at all.
However, do remember that patients do get pregnant even after a failed IVF cycle in their bedroom. The chances of this happening depends on the reason for the infertility.
Of course, if you have blocked tubes , or the reason for your infertility is azoospermia, then you're not going to get pregnant on your own.
But if your diagnosis is unexplained infertility, you could still get pregnant after a failed IVF cycle.
It's sometimes hard to give a medical explanation for this, but one possibility could be that the IVF cycle helps to improve your awareness of your own fertile time, and therefore you're much more aware of when you should be having intercourse.
Also, it's possible the superovulation helps to boost your fertility, and this effect persists for a few weeks after the failed IVF cycle.
So please  don't get disheartened if the IVF cycle fails -the more often you continue having sex, the better your chances of getting pregnant !

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




Saturday, September 21, 2019

Reducing your IVF risks




Every IVF cycle involves an element of uncertainty in the sense that the outcome cannot be predicted and you can never be sure whether you'll get pregnant in your first cycle or whether you will get pregnant in your fourth. And which is why patients aren't sure whether they should give up or maybe change the doctor or consider third party reproduction.
Yes, it's true that every cycle entails a risk, but you need to remember that this risk is predominantly financial and emotional. As far as medical risks go, if you're doing IVF in a good clinic, you don't need to worry about the impact either on your own body or on that of the baby because IVF is a tried and tested treatment.
A lot of what you read about the risks of breast cancer being increased or weight gain are lot of old wives' tales and don't really withstand scientific scrutiny. This is because these hormones are natural hormones which get excreted promptly.
So, make sure you've done your homework from reliable websites and talk to your doctor to make sure that you know exactly what you can do to reduce your risk and increase your chances.
What to find an IVF clinic which respects your time and intelligence ?

Friday, September 20, 2019

What happens after the embryo transfer ?



The two week wait ( 2ww) after an embryo transfer can be an extremely stressful time, because in one sense you're partially pregnant.
This might seem to make no logical sense, but because you know the doctor has transferred an embryo in your uterus,  in one sense you are pregnant, but on the other hand , implantation has still not occurred. In one sense, you are in a no woman's land , and you're never sure what you can do to increase the chances of the embryo implanting.
The biggest fear is that if you do something wrong , the embryo will fail to implant.
The reality is there's nothing much which you or your doctor can do during this waiting period.
You just have to take the medications which the doctor prescribes - estrogen and progesterone , to provide luteal phase support.
But beyond this, there is no special precaution you need to take. There's absolutely no need for bedrest or dietary precautions.
You should lead a normal life , because your embryo is safe in your uterus, like a pearl in an oyster.
Whether it's going to implant or not is not something anyone can predict or control or do anything about !

Thursday, September 19, 2019

Poor quality IVF treatment !


This is a great example of the kind of poor quality treatment IVF clinics in India provide !

What is a Grade 1 embryo ? And how many embryos were transferred ? How many cells were they ? Where are the photos of the transferred embryos ?

Self-inflicted infertility



This might seem like a surprising diagnosis, but often the cause for the infertility is ignorance.
Interestingly, this is true , no matter how sophisticated or educated the infertile couple is.
Many of them don't understand basic reproductive biology , and are very confused as to how to calculate their fertile time is. Thus, many women don't know what Day 1 of their cycle is. They haven't been told that Day 1 =  the day their menstrual period starts, and will often count the day the flow stops as being Day 1 !
They are smart enough to buy Apps and use ovulation prediction kits to track ovulation,  but often they end up misusing them, because of all the myths and misconceptions they already have.
It's simple stuff, but the reason they make these errors is because they assume they already know how to determine their fertile time, based on the second hand distorted information they get from their friends; or they are too embarrassed to ask their doctor such basic questions, because they don't want to share their ignorance !
Sadly, doctors can also contribute to this mess. Thus, many doctors advice couples to have sex frequently around Day 14, based on the simple assumption that ovulation occurs for women on Day 14. Now this may be true in text books, but real life is very different. Also, many doctors don't seem to know that the woman's fertility drops after ovulation, because her cervical mucus dries up, and creates a barrier for sperm entry !
What to find an IVF clinic which respects your time and intelligence ?

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 https://www.drmalpani.com/knowledge-center/articles/theinfertileman
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 ?
WhatsApp us at https://wa.me/919867441589/





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





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





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 www.drmalpani.com/free-second-opinion so that I can help you to have a baby !












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