Why a Root Cause Analysis is often useless in patients with IVF failure

Many patients who fail an IVF cycle, want the doctor to tell them exactly why the cycle failed. They want the doctor to get at the root cause , and this is completely logical. After all, once the root cause has been identified, the doctor will be able to fix the problem, and the next IVF cycle will succeed.

Sadly, life doesn't work this way, because biological systems are complex, and it's not possible to get a simple answer to what seems to be a very simple question. This is because there are multiple interlocking parts , and it's not possible to tease them out individually to find out why a particular cycle failed.

The reality is we can't even find out why a particular IVF cycle succeeded, but obviously when it succeeds everyone takes that for granted , and no one asks us why the cycle succeeded. But just like we can't answer why a particular embryo implanted successfully, we can't answer why a particular embryo didn’t implant.

Now it's very tempting to do lots of tests to find out what the “ underlying reason “ for the failure is . There are lots of complex expensive tests available, and doctors love doing these ! They include operations such as a hysteroscopy to check the uterine cavity, and an embryo biopsy to do a genetic analysis of the embryo. And these tests seem to make a lot of logical sense as well. After all , if you transfer an embryo into the uterus and it doesn’t implant, clearly this means there’s either a problem with the embryo or with the endometrium , and we just need to run tests to find out what the problem is, so that we can fix it and prevent a failure, the next time around.

Now, just because it sounds logical doesn't mean that it's feasible. The sad truth is that while it's easy to do the tests, interpreting them is extremely hard , simply because there's so much overlap between the results in fertile patients and infertile patients – and even in the same patient from one cycle to another . Most of these tests are unreliable and give inconsistent information, which actually ends up misleading both the doctor and the patient . They then go around chasing red herrings , which don’t help.

A classical example for this is a positive TB PCR test for the endometrium. Now this is positive in lots of fertile women as well , but fortunately they have enough sense not to do the test ! Now , when this test comes back as positive in a patient with a failed IVF cycle the doctor is delighted and says - See, this was the reason the cycle failed ! We have pinpointed the cause of the failure, and once we treat this, your next cycle will succeed. The patient is also pleased that the doctor has been so thorough and careful in identifying the problem and treating it.

 However, the ugly truth is that this abnormality wasn't the reason for the failure at all. It’s just an incidental finding, which doesn't actually affect embryo implantation at all. However, it’s hard to explain the concept of false positives and base rates to patients, because this is a complex and difficult topic, and most doctors don’t understand this themselves.

This is why most doctors will just mindlessly do the tests. They are happy to do these, partly because that's what their patients expect – and partly because it helps them to make even more money, even though they know in their heart of hearts that these tests are quite useless.

Now , every once in a while, the doctor will “ treat “ the abnormal test result and then do an IVF cycle and the patient will get pregnant. And in the doctor's mind - and the patient’s as well - the patient got pregnant because the doctor did the test , made the right diagnosis and corrected the abnormality.

However, this can be extremely misleading, because it's easy to confuse correlation with causation . The truth is that it's quite likely that even if the “ abnormality “ hadn't been treated , the patient would have got pregnant in the next cycle because IVF success is often a matter of randomness . Just being perseverant and patient is often all that it needed – there’s no need to change the treatment protocol if the cycle went well.

After all, human reproduction is not efficient, and even a fertile couple doesn't have a 100% chance of getting pregnant in the bedroom in the first month when they try . This doesn't mean that they change partners or do anything differently in the second month !

Unfortunately, this is not something which patients understand , because they expect instant gratification and 100% success rate when doing IVF .

And sadly, doctors aren’t  willing to share the truth with them , because doctors want to provide answers – after all , this is what patients expect, and they want to be seen as omniscient experts !

So rather than spend a lot of time explaining why we can't find out what the root cause is , and why running more tests is a waste of time and money, doctors are happy to pander to the patient's demand to do the tests.

This just adds to the confusion – after all, the more the tests you do , the higher the probability that some will be abnormal ! This is why these mindless battery of tests are so harmful. They cause the patients to waste a lot of time, money and energy on treating completely irrelevant abnormalities, which are of no clinical importance whatsoever.

The good news is that you don't need to do a root cause analysis because we have so much experience in treating patients who failed IVF cycles in the past. Empirical therapy works extremely well, so that instead of wasting time asking unimportant irrelevant questions which the doctor can't explain, you need to focus on what is in the doctor's control .

Make sure the doctor transfers a top quality blastocyst, and gives you photos of your embryos – this is all what the doctor can control. But do remember that after the doctor has made the embryo and put it back in your uterus, he has no control over whether it's going to implant or not, because embryo implantation is still a blackbox.

Not everything is within our control , and that's something which both doctors and patients need to come to terms with . A little bit of humility and a little bit of patience are invaluable .

Please remember the Serenity Prayer

God grant me the serenity to accept the things I cannot change;
The courage to change the things I can;
And the wisdom to know the difference.

Good doctors don't waste time looking for problems - they look for solutions ! 

What infertile couples need to do to make the right decisions for themselves

One of the hardest things about infertility treatment is making the right decisions.

Indian patients expect their doctors to make medical decisions for them . After all , doctors are medical experts , and that’s what they charge their professional fees for – to give their opinion. Most patients aren't sure they know enough to be able to make the right decision for themselves, which is why they would much rather outsource it.

Many Indian doctors are happy to be paternalistic and to make these decisions for patients , because they think patients aren’t able to make such complex decisions for themselves.

However, mature doctors understand that human reproduction is a very personal and a private affair, and there is no one single right answer for every couple.

This is why they ask their patients for their inputs . However, patients are often not confident enough to speak up . And sometimes some of them wonder why the doctor is asking them their opinion - after all , isn't the doctor supposed to tell them what to do !

This creates even more tension in the room, leaving both patients and doctors unhappy and dis-satisfied.

 Now, making decisions depends on both finding out the right facts, as well as listening to your feelings. For learning more about infertility and your treatment options, please go to www.drmalpani.com. There’s a wealth of updated, reliable, authentic, trustworthy medical information created by IVF specialists, and written for patients. These facts will also allow you to ask your doctor more intelligent and pointed questions.

 However, as far as listening to your feelings goes, that's something which only you can do for yourself. Yes, this is complex, partly because you've never had to make such difficult decisions in the past, and partly because this is not a decision you can make in isolation . You also need to think about your spouse's opinion, and get buy in from the rest of the family , especially for decisions such as adoption, which you may not have the freedom to make by yourself.

 Having said all this, please remember you're not the first couple in the world who is being confronted with this problem. Other people have dealt with it successfully , and your chances of being able to do so are excellent as well.

Please don't get disheartened ! Finding an empathetic doctor ; talking to friends and family members ; and a therapist or counselor can help you sort out your options , so you make a decision which you're at peace with . Remember you're going to have to live with the consequences of this decision for the rest of your life, so please use your head, your heart, your soul and your guts when deciding.

 There is no wrong decision – you just need to find the one you are comfortable with !

 

Cost Effective Baby Making at Home using the Malpani Baby Kit

 The Malpani Baby Making kit is an extremely cost-effective option for couples who can't get pregnant because of sexual dysfunction; because of unexplained infertility; and those who have problems with scheduling intercourse during the fertile time because of their work commitments.
While going to a doctor for treatment is always an option, this can be extremely expensive.
You need to go to the doctor multiple times during one cycle , and the costs add up very quickly. Also, because the success rate is not 100%, you may need to repeat your treatment over many months .
To add insult to injury, not only are doctor’s visits are expensive , so are the ultrasound scans and the actual insemination procedure, because doctors charge a pretty penny for their services.
And let’s not even talk about the embarrassment and dignity of lying on the examination table, with your legs up in the air , with all kinds of strangers coming and going , without a thank you or by your leave ! 
The Malpani Kit costs less than one visit to the doctor , and because you can do three inseminations in one cycle , this allows you to maximize your chances of getting pregnant quickly.

You can buy the Self Insemination Kit online at https://www.drmalpani.com/knowledge-center/resources/tools/self-insemination-kit-india

Why waste money and time going to a doctor when you can make a baby using the Malpani Baby Kit in your bedroom ?

 Many infertile couples automatically assume that if they can't get pregnant on their own, they're going to require medical attention , and seek out a gynecologist for assistance.
While this is true for many couples, there are also lots of others who can solve the problem for themselves in the bedroom using simple medical tools, especially when the problem is a mechanical one  of their being unable to deposit the semen in the vagina.
Part of the of the problem is most doctors will not explain this simpler option to them , because treating patients is their only source of income, and they can't afford to give away their trade secrets.
This is why the Malpani Baby Making Kit is such a valuable option - especially for couples who can't get pregnant because of sexual dysfunction . 

You don't need to pay the doctor to artificially inseminate you, when you can to the self -insemination for yourself !
The Kit allows them to bypass the problem in the privacy and convenience of their bedroom, which means it’s much less expensive !
Also, they don’t have to undergo the embarrassment and expense of having to go to a doctor to solve such a simple problem . 

Self-help is the best help after all !
Doctor’s visits can be expensive, because you need to go to the clinic many times in one cycle – and you may need to repeat the treatment over many cycles.
 This option of doing the self insemination for yourself can be extremely empowering and very satisfying , because you are now back in control, and don’t have to depend on the doctor to help you to make a baby !

You can buy the Malpani Baby Making Kit online - for less than the cost of a medical consultation with a specialist. And since it's been designed by IVF specialists with over 50 years of experience, we can assure you it's safe and effective.

Why Baby Making Kits are so cost effective !

 While it's reassuring to remember that in case your infertility is due to a medical problem, you can always go to a doctor to seek medical help , the fact still remains that going to a doctor is an expensive exercise.
You need to pay the consultation fees; you need to pay for the medicines; you need to pay for the scans and the treatment; and you need to take time away from work and make excuses for being absent.
Also, doctor’s clinics can be scary and intimidating. They poke and prod you; force you to assume highly undignified positions;  disregard your privacy; and every time you go, there is a new stranger who asks you personal questions, which you are fed up of answering. All this can be embarrassing and discomfiting as well.
This is why seeking medical attention is not something which any sensible patient looks forward to . This is especially true when you have a problem of sexual dysfunction – one which you can fix for yourself , and don't necessarily require all the bells and whistles which doctors provide .
Sadly, doctors will not explain this self-help option to you, because doing an insemination helps them do earn their living, which is why they will not provide you with information about simpler , less expensive alternatives, which you can do for yourself .
This is why the Malpani Baby Kit is so valuable for patients who want to try getting pregnant for themselves, without having to suffer the indignities of repeated medical visits.

How impotent man can have a baby in their bedroom using the Malpani Baby Kit

One of the problems of being infertile because of erectile dysfunction ( impotence) is that these men can’t stop thinking of themselves as failures . They can't even do such a simple thing like making a baby in their bedroom - something which millions of men have been doing since time immemorial !

The problem is compounded by the fact that their wife will often blame herself. She will feel that her husband does not find her sexually attractive, which is why he is not able to get an erection when have sex with her.

This can be hard to come to terms with - specially for many young successful professional men who are so used to getting everything they want in life. They are smart; they do well in exams; they get the job which they want ; and marry the wife they want to. Then when they find that they can't get their wife pregnant because they aren't able to have sex with her, their self-esteem takes a big toss , and they start wondering whether they are good for anything at all. 

This actually makes a bad problem worse, and becomes a self-fulfilling negative vicious cycle. Since the commonest reason for the situational erectile dysfunction is psychological, this gets worse over time. 

It's the elephant in the room, which neither partner is willing to bring up, because it's such a touchy and sensitive issue.

This can create an existential crisis, because this is the first  time in their life they are being forced to come to terms with their own biological frailty – that not everything is in their control.

One option is to seek medical assistance, but this is expensive and time consuming - and extremely embarrassing as well !

The good news is that the Malpani Baby Making Kit now gives them back control, so they can resolve this problem for themselves, in the privacy and comfort of their own bedroom

Taking back control ! Self Insemination Baby Making Kits for women with vaginismus

One of the problems of being infertile because of vaginismus is that women can’t stop thinking of themselves as failures . They can't even do such a simple thing like making a baby in their bedroom - something which millions of women have been doing since time immemorial !

This can be hard to come to terms with - specially for many young successful professional career women who are so used to getting everything they want in life. They are smart; they do well in exams; they get the job which they want ; and marry the husband they want to. Then when they find that they can't get a baby, their self-esteem takes a big toss , and they start wondering whether they are good for anything at all. 

This can create an existential crisis, because this is the first  time in their life they are being forced to come to terms with their own biological frailty – that not everything is in their control.

The good news is that the Malpani Baby Making Kit now gives them back control, so they can resolve this problem for themselves, in the privacy and comfort of their own bedroom

Free Highly Accurate Medically Tested Fertility Calculator

 

When you are using the Malpani Baby Kit for doing your self-insemination, it's very helpful to know what your peak fertile days are , so you can do the inseminations on those days to maximise your chances of getting pregnant quickly.You can use the Free Malpani Clinic Online Fertility Calculator to determine your peak fertility dates.

• You can choose to get the fertile days for the next 3 months to over the next 1 year.
  
  
• Once you have the dates, you can set up FREE EMAIL REMINDERS


• The Calculator calculates your most fertile days based on the fact that:
  1. Ovulation occurs 14 days before the next menstrual period is due.
  2. Fertility peaks on the day of ovulation and for 4 days prior to this.

These are the days you should do your insemination

Please share these with your husband, so you are both prepared - physically and mentally as well. 

 We can do this automatically for you at https://myfertiletime.in/fertility_calculator.php

Malpani Clinic's Free Automatic Fertility Calculator !

• Use the Malpani Clinic Online Fertility Calculator to determine your peak fertility dates.
  
  
• You can choose to get the fertile days for the next 3 months to over the next 1 year.
  
  
• This is helpful for couples who want to time "baby-making sex".
  
  
• Once you have the dates, you can set up FREE EMAIL REMINDERS


• The Calculator calculates your most fertile days based on the fact that:
  1. Ovulation occurs 14 days before the next menstrual period is due.
  2. Fertility peaks on the day of ovulation and for 4 days prior to this.

 We can do this automatically for you at https://myfertiletime.in/fertility_calculator.php

Why you don’t always need to go to a doctor to make a baby

Most couples can happily make babies in their bedroom. While this is true for about ninety percent of the couples who are fertile, unfortunately, there will be a minority who are not able to get pregnant on their own.
For example, they could have sexual dysfunction such as vaginismus or erectile dysfunction , and this can be frustrating , because they know that this is a simple hurdle to solve , but don't know what to do about it .
It can be quite embarrassing , frustrating and expensive to go to a doctor to fix this issue. It would be so much easier, kinder and better if you can do this in the privacy of your own bedroom !
The good news is we now provide you with the Malpani Baby insemination kit so you can solve your problem for yourself.
Think of it as being able to perform Baby-Making Sex , without the inconvenience and expense of having to go to a doctor ! This can be empowering because you can now take control, and are no longer dependent on the doctor.

We look forward to helping you to have a baby !

The Malpani Baby Making Kit is designed by IVF specialists to help you to have a baby !

 

The reason the Malpani Baby Self Insemination Kit is very thoughtfully designed is because it consists of exactly the same medical grade equipment we use in our IVF laboratory when we do IVF .

This is what makes the Malpani Baby Kit so special – and this is why it’s such great value for money.

Some users get intimidated when using it for the first time, because everything seems so strange and new , but the reality is that it’s surprisingly easy to use.

The instructions we provide are comprehensive, and our kit is packed with thoughtful products to make your life easier, such as individually packed sperm friendly lubricants in test tubes, in case you have difficulty producing a sample on demand .

Our sterile jars for semen collection have a very wide mouth , which means it's much easier for you to be able to collect a semen sample , without any spillage, rather than trying to collect your precious sperm in a narrow glass bottle, which most probably is dirty , and will kill all the sperms.

You can buy the kit online at https://www.drmalpani.com/knowledge-center/resources/tools/self-insemination-kit-india

We look forward to helping you to have a baby !

Why the Malpani Baby Insemination Kit is such great value

I was very interested to see the Mosie Baby website and the Mosie Baby Self Insemination Kit they sell. This contains two self insemination syringes , and a single semen collection cup , so couples can do a self insemination for themselves as home. They designed this based on their personal experience with having a baby, and wanted to help other infertile couples based on what they had learnt.

What I find interesting is we been selling a similar self insemination  kit for much longer ! However, we never branded it or marketed it so cleverly, and we need to fix this problem !

Ours is far better , because we provide three sterile disposable broad mouthed medical grade containers for semen collection – exactly the ones we use in the IVF lab. It is far safer and better to use a new container for every semen sample, rather than try to reuse a container by washing it. Water is sperm-unfriendly, and soap / detergent kills sperm.

 Also, our product is far better designed, because instead of using syringes for doing the insemination ( not something which syringes were designed to do, which is why when a doctor does an insemination, they use a plastic sterile disposable catheter with it), we provide sterile disposable medical grade Pasteur Pipettes. These are much easier to use, and are specifically designed to handle semen samples . This is exactly the same product our embryologist uses in the IVF lab when handling your semen.

Also, because we provide 3 Pasteur Pipettes in each kit, you can do more inseminations in a single cycle , and this increases your chances of getting pregnant . Also, we are much less expensive – our cost is about one third the cost  of the Mosie Baby Kit !

Having a baby at home using the Malpani Baby Self Insemination Kit

 

One of my patients directed me to the Mosie Baby Kit on the Mosie Baby website, and I was very impressed.  This is a kit which has been designed by an infertile couple, so they could do a self insemination for themselves , and it’s far better than using a turkey baster, but I think it's extremely expensive. At about 89 US dollars for a single kit ( which allows for only two inseminations in one cycle, it’s not something which Indian couples will be able to afford.

Our kit is much less expensive - and allows for 3 inseminations per cycle !

Also, while they provide specially designed syringes for handling the semen, and these are definitely better than the regular syringes which you can buy in the pharmacy , these are still inferior to the sterile plastic medical-grade sperm-friendly Pasteur pipettes which we provide in our Malpani Baby Self-Insemination Kit.

And while they claim their kit is good because it is designed by an infertile  couple , please remember that ours has been designed by IVF specialists with over 30 years of experience, who have helped thousands of couples to get pregnant !

We look forward to helping you to have a baby !

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0:07 / 8:12 Miscarriages after IVF - Why do they occur and how to prevent them ?

Mosie Baby Kit vs Malpani Baby Kit for Home Insemination

 I was very happy to see the Mosie Baby website , where they sell the Mosie Baby Kit for doing a self insemination at home. The reason I liked it is because it's been thoughtfully designed by an infertile couple , who have used it for themselves .
It’s packed with a lot of information , which will be very useful for patients who are doing home inseminations to have a baby.
We have been selling a Home Insemination DIY Kit for many years, and are now going to re-name our boringly named Self-Insemination Kit ( what else did you expect a doctor to call this ?) as the Malpani Baby Kit.
The good news is our kit offers much better value for money !
Not only is it much less expensive than the Mosie Baby Kit, it is better designed , because instead of using a syringe for doing the insemination , we use the exact same sterile disposable non-toxic plastic pipettes which we use in the IVF lab for handling sperm samples.
These are medical grade products, and by using these , your chances of getting pregnant at home increase considerably !
We look forward to helping you to have a baby !

Mosie Baby Kits for Self Insemination

I have been very impressed with the Mosie Baby website , but this is not because I think that the Mosie Baby Kit is better than our self-insemination kit. In fact, I think our home-insemination kit is far better because it allows for more inseminations per cycle; is much less expensive; and it’s better designed, because it uses Pasteur pipettes fir handling the semen ( just like the IVF lab does) , rather than syringes.

Also, patients have been using our kit for many years, which means we have far many more success stories to tom-tom about , while they are still the new kids on the block.

However, what I really liked about them is they have marketed and packaged and sold it well. Of course, the problem with all these additional bells and whistles means their product is much more expensive, which means they charge about US $ 89 for 2 inseminations per cycle – about 4 times as much as we do !

We look forward to helping you to have a baby !

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