Friday, March 06, 2020

Head versus heart in IVF



Many educated patients find it very hard to deal with IVF failure, especially when the cycle was perfect, and the doctor transferred a top quality blastocyst into the uterine cavity when the endometrium was receptive.
After all, the doctor did everything possible, and the blastocyst looked perfect, the endometrium was 8 mm and trilaminar, the transfer went smoothly and the doctor was really optimistic !
So then why did the cycle fail ?
The reality is they understand that medical science doesn't have the answers to all their questions, but they find it very hard to accept this.
Because they are educated , they expect that medical science will have all the answers.
However ,  we need to accept the limitations of medical technology . After  all, when we put an embryo back in the uterus, we can't monitor or track or control what is happening to it. This is a microscopic ball of living cells, and implantation is a biological process which is notoriously inefficient !
The problem is these patients are emotionally very vulnerable , and don't want to accept the truth that not everything is in our control !
They want answers, which is why sometimes doctors end up manufacturing them , just to keep them happy, by running additional expensive genetic tests and offering experimental expensive unproven treatment. Sadly, this doesn't help them reach their goal at all, and just ends up making them waste money !

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






Do’s and don'ts after the embryo transfer.



Lots of patients are very worried that they will do something stupid after the transfer, which will reduce the chances of their embryo implanting, and cause their IVF cycle to fail.
These anxieties usually falls into the category of foods which they eat; (hot foods or cold foods); or physical activity. For example, they are scared that lifting weights , or the bumpy ride on Indian roads may dislodge the embryo.
This is why many doctors are happy to give them a long list of do’s and don'ts. Mother-in-laws and mothers and aunts will also chime in, with many old wives' tales. And friends who are pregnant will be happy to add their 2 cents !
The truth is that the natural place for an embryo is the uterus – it’s its natural sanctuary ! An embryo in a uterus is like a pearl in an oyster – it’s safe and secure and nothing you can do can dislodge it, so you really don't need to worry.
Remember that an IVF pregnancy is exactly like a natural pregnancy – the only difference is that you happen to know there is an embryo in your uterus ( which fertile women who are having baby making sex don’t !)
Whether the embryo spends five days in the test tube in the IVF lab, five days in your fallopian tube inside the body doesn't matter – once it reaches the uterus, it’s safe.
Of course, whether it will implant or not is not something we can control – that’s still a biological process we cannot influence as yet !


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





Wednesday, February 26, 2020

What should a patient do when IVF doctors disagree ?




Infertile couples are often very confused when they go to IVF doctors , because they get widely varying different opinions , and they're not sure whom they can trust.

There are many reasons why IVF doctors don’t agree with each other.

For one thing, our IVF technology is still not perfect, which means we still cannot even make an accurate diagnosis, and have to label many couples as having “unexplained infertility” because we cannot clearly and accurately identify the underlying problem.

Because no one really knows what the truth is, everyone interprets tests the way they want, based on their experience and preconceived notions, and there’s no right answer !

The second big problem is that there are two important variables which influence the diagnosis and treatment of infertility. One is called the “ trying time” -  how long an infertile couple has been trying to get pregnant; and the second is the fact that the”  natural history “ of untreated infertility is unpredictable.

Thus, even infertile couples who haven't been able to get pregnant for five years, could still perhaps get pregnant on their own, if they continue trying.

This is why the individual doctor's personal preferences are going to influence what the doctor advises the patient, because they are so swayed by their personal experiences and anecdotal success stories.

Thus, some doctors are aggressive , and will advise IVF for everyone, whereas others are much more conservative , and will want to explore simpler options first, before advising IVF.

Patients need to recognize this subjectivity, and find a doctor whose preference and philosophy matches theirs !



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





Tuesday, February 25, 2020

Please don't abandon your embryos !




As IVF technology gets progressively better, we're able to grow more eggs and create more top quality embryos. Now we can't transfer all the embryos at a time, because of the risk of a multiple pregnancy, which means patients are left with supernumerary (spare ) embryos. We encourage all patients to freeze their spare embryos , because each embryo is worth its weight in gold.
Our technology for freezing and storing embryos using the technology of vitrification has become so good that survival rates after thawing are practically 100%, which means the pregnancy rate with these embryos is as good as with fresh embryos !  And the cost of doing a frozen –thaw cycle is much less because it's so much simpler and easier – you don’t need to take any injections at all !
So if you do have spare embryos, please freeze them. Yes, freezing will add to your cost up front, but it's a very worthwhile investment.
And the bonus is that if you do get pregnant with your first transfer, you can use your frozen embryos for your next baby, to complete your family !


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





Monday, February 17, 2020

Why testing for failed embryo implantation in IVF patients is useless



One of the big problems with IVF is the uncertainty which surrounds it – no one knows which cycle will work, or why perfect cycles fail.
What makes a bad problem even worse is that patients have unrealistic expectations of the technology. Sadly, doctors compound the problem by pandering to the patient's demands. They offer to provide answers by running many expensive, complex, exotic and esoteric tests, even though they know the reality is that these don’t provide any useful information.
This is because embryo implantation is a complex biological process, which we cannot control and we cannot monitor, and we still don't know which embryo will implant , and which ones won't.
Doctors are worried that if we tell the patient the truth – that we don’t have all the answers – that patient will no longer respect us . This is why we subject them to the “latest and newest”  tests, to demonstrate that we're trying to figure out exactly what the problem was.
However, this just means that we're taking the patient for a ride, because we don’t tell them to truth about the limitations of these tests, and that they won’t change their treatment options.
Yes, the patient ends up  spending a lot of money, and this is good for doctors because they can charge more, but the test results don’t provide any useful answers , which means the doctor remains in the dark – but he can cloak his ignorance using fancy medical jargon !

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






Friday, February 14, 2020

IVF Video : Empiric therapy in IVF

IVF Video : Why are IVF patients scared of finding out more about IVF ?

IVF Video : Treatment for recurrent pregnancy loss

IVF Video : The donor egg IVF option

IVF Video : Third party reproduction and the movie, Good Newwz

IVF Video : Why eggs are more important than the sperm or the uterus in IVF treatment

IVF Video : Please ask your IVF doctor questions!

IVF VIdeo : Why the IVF hormones don't cause cancer or early menopause !

IVF Video : Making sense of the semen analysis report

IVF Video :" How IVF failure can lead to success !

IVF Video : Why young professional women should explore the option of egg freezing

IVF Video : Blastocyst transfers maximise IVF pregnancy rates

IVF Video : Should infertile couples go to gynecologists ? or IVF specialists ?

IVF Video :Is your IVF clinic a full-service IVF clinic?

IVF Video : What infertile women need to know about their AMH levels

IVF Video : Frozen eggs are a better option for donor egg IVF

IVF Video : The AMH blood test can help women to track their fertility

IVF Video : Why single embryo transfers ( SET) have a higher pregnancy rate

IVF Video : Day 3 or Day 5 Embryo Transfer. Which is better?

IVF Video : IUI क्या होता है ? | Intra-Uterine Insemination Explained in Hindi

IVF Video : Self Inflicted Infertility

IVF Video : HOW TO GRADE EMBYOS in (hindi)

IVF Video : Learning from a failed IVF CYCLE

IVF Video : Donor Egg Vs Surrogacy

IVF Video : Preimplantation Genetic Diagnosis and Preimplantation Genetic Screening Explained in Hindi

IVF Video : Career Vs Baby

IVF Video : 4 things, all Infertile Couples are fed up of Hearing

IVF Video : BOUNCING BACK AFTER A FAILED IVF CYCLE

IVF Video : 5 Things Every Infertile Couple Wishes their Friends knew about Infertility

IVF Video : WHY DO IVF CYCLES FAIL ?

Tuesday, February 11, 2020

Why IVF doctors disagree


Infertile couples are often very confused when they go to IVF doctors , because they get so many different opinions , and they're not sure whom they can trust.
There are multiple reasons for why IVF doctors will often give widely varying opinions.
For one thing, a lot of our technology is still not perfect, which means we cannot make an accurate diagnosis in reproductive medicine. This is why two different doctors will interpret the same test result in diametrically opposite ways !
Also, we need to remember that making babies involves a couple, which means the fertility of a couple will be the sum of the fertility potential of both the partners . This is why answers are never in black or white - they are always shades of grey ! It's possible that if an "infertile man" marries a very fertile woman, he will be able to get pregnant.
Also, time plays a key role is the final outcome . Trying time - the time for which an infertile couple has been trying to get pregnant is a very important dynamic variable, which means the way we treat a recently married couple is very different from the way we treat one who has been trying for more than one year - even of their test results are identical !
The problem is that the natural history of fertility is difficult to interpret, because we all know infertile couples who  haven't been able to have a baby in the bedroom for five years, who still get pregnant on their own, for no clear reason. Of course, if they got pregnant after the doctor's "treatment", he is going to take all the credit. These anecdotal success stories bias the doctor, and his individual personal preferences are going to influence what he advises his patient. Some doctors are aggressive and will advise IVF for everyone, whereas others are much more conservative - and patients need to recognize this difference !

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






Monday, February 10, 2020

The problem with IVF tests


A big problem with IVF is the uncertainty which surrounds it, because no one knows which cycle is going to work.
Patients have unrealistic expectations of IVF technology, and when the cycle fails, they demand scientific answers for why it failed !  And doctors compound the problem by running even more tests, in order to "diagnose" the cause of the failure.
However, the reality is that they're not able to do this because embryo implantation is a complex biological process, which we cannot control and we cannot monitor. After all, there is no way of being able to track the fate of a microscopic ball of cells once we put it back into the uterus !
The truth is that don't know which embryo will implant and which one won't - and we need to have the guts to share our ignorance and uncertainty with our patients.
However, IVF doctors are worried that if we tell the patient the truth , they will no longer respect us . This is why researchers manufacture a lot of very expensive , esoteric  and exotic tests , in order to demonstrate to the patient that we are trying to figure out exactly what the problem was !
However, the reality is we're just taking the patient for a ride ! When patients spend a lot of money, this is good for the doctor, but these tests don't provide any useful answers , because they are experimental and unproven.

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

Friday, February 07, 2020

If you have only two embryos, should you transfer both of them ? or should you transfer one and freeze the other one?



If you have only two embryos, should you transfer both of them ? or should you transfer one and freeze the other one?
This is a common quandary for patients with a poor ovarian response !
If you have 2 top-quality blastocysts, what should your strategy be ? Should you transfer one and freeze the other ? Or transfer both together?
If you put both together, you increase your chance of getting pregnant in that cycle - but this is an unfair comparison - after all, you shouldn't compare apples to oranges !
You should compare transferring two embryos at one time , with transferring one embryo at a time in two consecutive cycles.
And the pregnancy rate with transferring a single embryo in two consecutive cycles - a sequential single embryo transfer ( SET) is actually better , because you need to add the chances of getting pregnant in two cycles.
The cumulative conception rate with two SETs is better that transferring two embryos in a single cycle.
The risk for the babies is also less, because you don't have to worry about the problem of preterm births because of a twin pregnancy


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





Thursday, February 06, 2020

Should you do a Day 3 or a Day 5 transfer if you only have a single embryo ?



Should you do a Day 3 or a Day 5 transfer if you only have a single embryo ?

 If you have lots of embryos, then it makes sense to grow them up to Day 5 ( blastocyst stage) because the embryologist can then select the ones which are growing the best , and transfer these, to maximise your chances of implantation.

Suppose you only have a single embryo on Day 3? Should you transfer on Day 3 ? Or should be willing to wait till day five? Now, this is a dilemma, because if you wait till Day 5 and it arrests in the lab, you'll have no embryos to transfer.  Many patients - and doctors - will say, "A bird in the hand is worth two in the bush," so we might as well put it back inside the uterus , even though the uterus may not be the best place for a Day 3 embryo. After all, why take a chance? And if it's going to implant, it may very well do that.

This is especially true for poor quality IVF clinics, which aren't very sure about their laboratory conditions, and don't want to take a risk . They want to transfer the embryo back into the uterus as quickly as possible , because this way they can tell the patient, "Well, we transferred an embryo , which means we did our best. And if it didn't implant, that's your bad luck."

However , if you have the courage, you should be willing to wait till Day 5. If it develops to a blastocyst in vitro, it has a better chance of implanting. And if it is going to arrest, I feel it's better it does so in the lab for the following reasons.
1. This spares you the agonising 2 week wait , and you don't have to live in unnecessary suspense and uncertainty. False hope can be cruel !
2. While this option causes short term pain, it helps you make more intelligent decisions about what to do in your future IVF cycles . Thus, it's easier to come to terms with the fact that you maybe better off using donor eggs, rather than trying IVF again and again with your own eggs.



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





CAREER VS BABY - the Professional Woman's Dilemma

Friday, January 31, 2020

More proof that PGT for aneuploidy testing reduces IVF pregnancy rates

Outcome of in vitro fertilization cycles with preimplantation genetic testing for aneuploidies: let’s be honest with one another

Richard J. Paulson, M.D., M.S.

The process is, unfortunately, quite inefficient, and 50% of potential implantations are lost, even by clinics that have experience with PGT-A and are good enough to be chosen for the STAR trial. In an intention-to-treat analysis, the pregnancy rate is not increased. The time to pregnancy is not shortened and there is no decrease in miscarriage rates.
If 50% of potential implantations are lost, under what circumstances can we justify the use of PGT-A? We should begin by letting our patients know what the latest research shows. Informed consent should be fully informed.

Many IVF "add-on" procedures are of no value at all !

A definitive review article from the world's leading IVF journal, Fertility Sterility, Dec 2019 issue, which proves that many IVF-add on procedures which IVF doctors recommend do not improve IVF success rates !

These include 
 immune therapies, 
endometrial scratching, 
endometrial receptivity array, 
uterine artery vasodilation and 
human chorionic gonadotropin instillation. 

Doctors advice these to earn more money for themselves - not to help you !

Read this article, and share this with your doctor if he suggests these treatment options to you. Many will tout these as being the "latest and most advanced" !


In vitro fertilization add-ons for the endometrium: it doesn’t add-up

Wednesday, January 08, 2020

Why IVF is the best treatment option for couples with unexplained infertility


Unexplained infertility ( also known as idiopathic infertility) is a diagnosis we label about 10% of infertile couples with. This just means that our technology is not good enough for us to be able to identify why they are not being able to get pregnant in their own bedroom.
For example, the sperm count and motility maybe normal, but the sperm maybe functionally incompetent, and unable to fertilise the eggs !
This is why IVF is so useful. Not only is it a great diagnostic tool, because it allows us to document whether or not the sperm an fertilise the egg in the lab .
Much more importantly, IVF is a very effective option for these couples, because it allows us to bypass all the natural hurdles couples with unexplained infertility face in their bedroom. It allows us to create embryos in the lab, so we can directly transfer them into the uterus. This is the one option which maximises their chances of getting pregnant quickly !
After all, let’s not forget that infertile couples care much more about solutions, rather than about diagnosing their medical problems !
I am an IVF specialist with over 25 years of experience and our clinic , Malpani Infertility Clinic , has helped 1000s of couples to build a family. Please do not hesitate to contact me in case of any questions that you might have regarding IVF, I will be more than happy to help. I provide a free second opinion at www.drmalpani.com

Friday, January 03, 2020

Unexplained infertility - IVF as the ultimate diagnostic tool for infertile couples



IVF as great as a treatment option for infertile couples, because it is the final common pathway for bypassing all kinds of infertility.
However, please also remember  that it's a great diagnostic tool as well , because it provides us information which no other test can do today.
For example, lots of women don't get pregnant because their eggs are of poor quality; or the man's sperm count and motility may be normal, but the sperm is functionally incompetent. This is the problem of poor quality eggs and lazy sperm, but there's no test to assess gamete function currently, and these patients are often labelled as having "unexplained infertility" .
This is why IVF is so useful, because it allows us to see what happens when you put the eggs and sperm together in the test tube.
Are the eggs mature ? of good quality? Are they able to fertilize?
And are sperms able to fertilize the egg?
Fertilisation is the true test of the fertilizing capacity of the gametes, and the only way we can get that answer is by doing IVF !

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






Thursday, January 02, 2020

Why embryo pooling is a great option for older women who are doing IVF



We know that as women get older, their egg quality drops , as a result of which it becomes harder for us to retrieve eggs. Both quantity and quality are affected, and many of these eggs don't become embryos ; and often the embryo quality is poor as well.
For these women, because time is at a premium, we offer the option of embryo pooling, to maximise their chances of success.
We do multiple ( 3-4) fresh IVF cycles back to back, but don't do any transfers. We collect all the eggs; fertilise them; and freeze all the embryos on Day 5. Dr Sai has mastered the vitrification process for freezing embryos, which means our survival rate after thawing the frozen embryos is 100%.
Though this option is more expensive , because you need to do more fresh cycles , it increases the number of options that you have of getting pregnant. This can make a world of a difference, especially for an older woman.
Once we have frozen enough top quality blastocysts for you, we can then thaw them and transfer them back into your uterus, one at a time.
And if you get pregnant with your first transfer, you can always keep your embryos for your second baby, because each embryo is worth its weight in gold !

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






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