Wednesday, October 28, 2020
The paradox of unexplained infertility - treatment is easier than diagnosis !
Whenever
infertile couples go to the doctor, they expect him to make a diagnosis , so he
can tell them what the reason for their infertility is. They know that once that's been established, the doctor can treat this and they can have a baby.
The reality is that we can't always find the cause for infertility in some couples. This is true in about 1 in 10 couples, and they are diagnosed as having unexplained infertility . This is really a non-diagnosis, and this frustrates patients. They feel the doctor is useless because he can't even find out what their problem is. Their biggest worry is that we can't find out what the problem is , how will we able to treat it ?
The reality is that the diagnosis of unexplained infertility just means that our technology is not good enough to pinpoint where the problem is. The good news is that our technology is good enough to bypass any problem ! At the end of the day , we shouldn't care about problems – we should only care about solutions !
Unexplained
infertility simply means that all the basic tests have been done , and
everything has been found to be is fine. In fact, you should be happy that everything is
normal, so don’t get upset please !
Even
though we have not been able to find out exactly what the problem is, but we
can still increase the chances of your egg and sperm meeting, so we can give
you a baby. Treatment options include IUI and IVF , and there's no need to get
distressed or upset if you are young, as the success rates for treating
unexplained infertility are very high.
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !
Queries about using the Malpani Baby Kit for Self Insemination
Patients often have many questions about how to use the Malpani Baby Kit for Self Insemination.
Here are the answers.
" We are planning for baby due to painful sex. We are trying home insemination. Through Youtube , we tried with a syringe last time . What we observed is almost all the liquid injected into vagina was coming out along with the syringe when it is pulled out. While surfing we came across your video and we are planning to buy your DIY kit. Have a few queries could you please provide your inputs.
1. With your kit ,when we insert the speculum ,won't it cause burning or pain inside vagina ? In that case can we use lubricant provided in your kit to apply on speculum or please suggest how to loosen vagina. I don't get lubrication properly.
You don't need to use the speculum if you don't want to. It's easy to insert the soft plastic pasteur pipette deep into your vagina . This will automatically deposit the semen near the cervix.
2. Through the pipette should we drop semen near the cervical opening or should insert pippet slightly to cervix opening.
Near the cervix is fine. Sperm can swim and will find their way to the cervical mucus, so please don't worry about this
3. With my previous experience injecting through a syringe I noticed almost all liquid came out of vagina, what should we do to make semen stay inside vagina.
Lie down with a pillow under your hips for a few minutes after the insemination
Leakage is normal . This happens after sexual intercourse as well, because the vagina is a closed blind tunnel/sheath
4.After sperm ejaculation how long the sperm should be kept outside, I mean should we wait before inserting into vagina after semen collection.
15 min is enough for it to liquefy
5. Is it necessary to get naturally lubricated inside vagina and get orgasm during this process ?
No, there is no relationship between sexual arousal, orgasm and fertility
5. Can the kit be delivered to my hometown which is small taluk in Karnataka.
Yes
You can buy the Malpani Baby Kit for Self Insemination. online !
Tuesday, October 27, 2020
The endometrium and infertility - what every infertile couple needs to know about the uterine lining
For an infertile couple, it can be quite scary to go to a doctor , because doctors use a lot of medical jargon .
Many of these are difficult long words, which are hard to pronounce, and which they have never heard before. The problem is compounded by the fact that most doctors never bother to take the time and trouble to explain the meaning of these terms.
One of these foreign words is the endometrium . Yes, this is quite a mouthful, but it’s just the scientific word for the inner lining of the uterus . Endo means inside , and metrium means uterus , so don't get confused .
If you are willing to be patient and do your research for yourself, it's very easy for you to get up to speed , because understanding the problem of infertility and its treatment is not very complicated.
After all, you only need four things to have a baby – normal eggs, uterus , sperm and fallopian tubes.
If there is a problem with the uterus lining or the endometrium, then this is easy to diagnose, using vaginal ultrasound scans.
The endometrium gets shed during the menstrual period as the menstrual flow, and at this time, the lining is thin. The uterine lining grows in response to the estrogen produced by the follicle during the follicular phase. Prior to ovulation, the endometrium is about 8 mm in size, and trilaminar in texture. This is reassuring, and suggests normal endometrial function.
In case the lining is thin, or distorted on the scans, this suggests there may be a problem with the endometrium , and the doctor can do a hysteroscopy to confirm this. Many of these problems - for example, an endometrial polyp, are easy to fix , provided you don’t allow the doctor to bulldoze you by using a lot of fancy medical terms which are designed to confuse you, rather than enhance your understanding.
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !
Monday, October 26, 2020
Tubal (ectopic) pregnancy - so near and yet so far !
Being infertile
is bad enough, but one of the biggest tragedies is when you get pregnant, but the pregnancy is not in the uterus , and is lodged in the fallopian
tubes. This is called an ectopic or tubal pregnancy. Implantation just a few centimetres from the right place can make such a big difference !
The risk of an ectopic pregnancy
is higher in infertile women , because often their tubes are partially damaged (
even though they are open, they may not be functioning properly). Sadly, we can't prevent this.
You can have an
ectopic pregnancy even after doing IVF , because even though we're transferring
the embryo directly in the uterus, it can travel backwards into the fallopian
tubes and get stuck there.
The problem with an ectopic pregnancy is that the fallopian tube is not
designed to allow a baby to grow , and if the diagnosis is delayed, the tube
can actually rupture, and this can be a life-threatening complication .
This is
why it's so important to monitor the early stages of pregnancy in infertile
women. You should test for pregnancy as
soon as possible . The doctor will monitor you by checking your blood HCG
levels and doing ultrasound scans , so that we can make a diagnosis as early as
possible.
The good news is that if this is done in a timely fashion, we can
kill the ectopic pregnancy with a simple methotrexate injection, so you don't
need a laparoscopy , forget about open surgery. The bottom line is that an
ectopic pregnancy is a problem which is easy to treat , if diagnosed in time.
The tragedy occurs when the doctor fails to consider this possibility, which is
why patients need to be well-informed, and ask the doctor to rule out an
ectopic. This can be tricky, because the symptoms of both an intrauterine
pregnancy and an ectopic pregnancy are exactly the same, which is why you need
to be proactive, and ask for the blood tests and scans.
Read more at http://www.drmalpani.com/knowledge-center/articles/ectopic
Saturday, October 24, 2020
Why I love answering IVF patient's questions
One of the commonest complaints which patients have about doctors is that they aren't willing to answer their questions.
For me, it's exactly the opposite , so if you want a doctor who is happy to clear your doubts, please talk to me. I love answering patient’s questions because these keep me on my toes.
Having to explain to patients means I need to simplify complex medical topics and strip them of jargon, so patients understand what I am saying.
More importantly , these questions help me to empathize with my patient , because I'm not a mind reader , and I don't know what their worries and anxieties are. If they ask questions, I can resolve these, and patients appreciate this reassurance.
More importantly , these questions help me to empathize with my patient , because I'm not a mind reader , and I don't know what their worries and anxieties are. If they ask questions, I can resolve these, and patients appreciate this reassurance.
Patients want openness and transparency, and if I can clarify matters for them, they don’t have to spend sleepless nights about a doubt which I could clear up if they'd asked me the question directly.
Finally, your questions also help me to generate content for my website , because if one patient has a query, it’s quite likely that others will have this too, and if I can answer these online, I can help many of them.
Remember that the word doctor is derived from the word, “docere”, which means to teach ! And I love prescribing Information Therapy – it’s free, and has no side effects !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !
Why I think aloud when talking to my IVF patients
I often think aloud when formulating the IVF treatment plan in front of my patients.
Now this might sound surprising, because most patients expect their doctors to
be expert oracles who tell them what to do.
I do this deliberately, because then they can see my thought processes , and on what basis I have made my decisions.
Medicine is a complex science, and the outcomes of IVF are always unpredictable,
When they can follow my logic, they know on what basis I have chosen a particular option for them. Making my reasoning open and transparent is helpful, because it allows patients to share in the decision-making process.
They can ask me why I prefer
a particular treatment plan, as compared to its alternative. It also encourages
them to offer me additional options to consider, so they can provide their own
inputs.
Because I'm thinking aloud, I have to be clear and cogent in my logic,
because I need to explain this to my patient. This sharpens my thinking, and
makes the patient much more involved and engaged in what's happening to them.
It also shows I respect them, and expect them to participate as partners in their treatment.
This
strategy helps me to demystify IVF for them, and they can see I am being thoughtful
and analytical when formulating a personalized treatment plan for them.
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !
Thursday, October 22, 2020
Pus cells in the semen - and how to make sense of the report
Pus cells are WBCs - white blood cells, and less than 5 pus cells / hpf is considered to be normal, but this finding is often highlighted in red as being abnormal, and this often causes both the doctor as well as the patient to worry.
The WHO Manual states that less than 1 million WBC per ml is normal, but the majority of labs never bother to measure the actual concentration of the WBCs - the technician simply eyeballs the sample and estimate this in terms of rounds cells seen in each visual field when scanning the samples through the microscope.
Patients are worried that these pus cells suggest they are suffering from an occult infection - perhaps a sexually transmitted disease ( STD) which they knew they had acquired in the past, and they are worried that they can transmit this to their wife.
They are also worried that this hidden infection can kill their sperm, or reduce their ability to fertilise the eggs.
Doctors are also happy to "treat" this abnormality by putting the man on antibiotics, because these are so easy to prescribe, and because this seems to be a logical thing to do. They hope these antibiotics will kill the bugs causing the infection, and this will boost the man's fertility.
The reason this is flawed logic is because the "pus cells" seen on a semen analysis report when checked through the microscope are simply round cells, which are misinterpreted as being pus cells .
When examining the semen under the microscope, it's very easy to identify sperm because they have a tail and are moving rapidly. However, seminal fluid also contains many other cells, including the epithelial cells which line the male reproductive tract, as well as sperm precursor cells.
Most laboratory technicians will report every round cell they see as a pus cell or a WBC , but most of these are actually immature sperm precursors, called spermatocytes or spermatogonia , which look exactly the same. However, most labs don't have the special stains needed to identify whether this round cell is a WBC or not , which is why they will report all the round cells as pus cells !
The doctor then promptly prescribes antibiotics, but this is a complete waste, because there was no infection in the first place, and antibiotics will not cause the sperm precursor cells to go away !
Patients end up wasting a lot of time and money on taking antibiotics . Some doctors will also send the semen sample to the microbiology lab to try to culture the microbe causing the purported infection. However, it's surprisingly difficult to culture the semen sample properly, because it's often contaminated with the commensals on the skin of the penis, such as E.coli , which causes further confusion !
The bottom line is if your semen report does show a few pus cells, please don't panic ! Please repeat it again, and ask the lab to do the special stains needed to check if these are actually WBCs.
Otherwise, your wife will keep on getting older and losing her fertility, while you waste time because of a poor quality laboratory, or a poorly informed gynecologist .