What makes you think you are a better IVF doctor than other IVF doctors ?

 

Most patients are too polite to ask me this question to my face, but this is the elephant in the room - Why should they choose Malpani IVF Clinic when they have so many other options ?

This is a valid question because every IVF clinic claims it is the best - and they all say they have the highest success rates !

It's very hard for patients to differentiate between a good IVF clinic and a not so good one, especially when all the websites look so similar , and everyone claims their pregnancy rate is an astronomical  70% to 80% !

This is why it's so important that patients learn to invest in Information Therapy . They need to be able to dig deep into whatever the IVF clinic is saying , rather than just blindly accepting any claim they choose to make.

What makes us special is the fact that we are a boutique IVF clinic ! We don't take pride in treating large numbers of patients , because we're not an assembly line clinic that is out to maximise its profits. We don't treat patients as widgets. We are a high-touch, high-tech IVF clinic where Dr Anjali and I take care of all our patients ourselves . We are a full service IVF clinic, and have a full-time embryologist , who has over 10 years of experience and expertise - Dr Sai.

As a team, we are extremely good at what we do , because we do nothing else other than IVF !

We provide a comprehensive range of services , all the way from IVF to PGD to TESA to donor egg IVF to adoption to surrogacy, ,  all under one roof . This means patients don't need to go anywhere else . Since we do only IVF , we are extremely good at what we do , because we have accumulated a lot of experience and expertise in this field over the last 30 years.

We don't dissipate our energies by going to other clinics , or by performing additional procedures such as laparoscopies, caesarean sections, or hysterectomies .

It is this deep and single focus on IVF that ensures that our patients are at the heart of everything we do .

Our only desire is to help you have a baby , and this is why we share so much information online , through our website at www.drmalpani.com , as well as our YouTube channel, so that patients like you can make well informed decisions for themselves

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 you should change your IVF doctor after a failed IVF cycle

Many patients write to me asking for a free second opinion after they have failed an IVF cycle.

It's very clear the quality of medical care they have received has been extremely poor - but sadly, they are blissfully unaware of this bitter truth. The documentation is pathetic ; the doctor has not bothered to do a blastocyst transfer ; and failed to provide photographs of the embryos which were transferred - all of which are red flags.

The first thing I tell them is that if you want to improve your chances of getting pregnant , you need to change your IVF clinic . If you continue taking treatment at a bad clinic, you will continue wasting your time and money , and your chances of getting pregnant will remian poor.

In fact, changing doctors is often one of the most effective things a patient can do , because the commonest cause of IVF cycle failure is suboptimal medical care . Sticking with the same doctor out of a sense of misplaced loyalty is just going to mean that you will continue failing cycle after cycle , and will end up never having a baby .

However , most patients are very reluctant to change doctors . Part of this is because of the " sunk cost fallacy ". Since they have already spent so much money on doing the first cycle in that IVF clinic , they are very reluctant to take the time and energy and trouble to find a new IVF clinic . They naively believe that their current doctor now understands their history , and since he has seen how they responded to the treatment, they will be able to do a better job with the second IVF cycle .

This is just a false hope . If your doctor has done a bad job in the first cycle , what makes you think he will magically improve and do a better job in the next cycle ? If it's a bad clinic , it will remain a bad clinic, and you will continue going around in circles .

However, most patients have too much inertia to take the time and trouble to switch doctors . This is an active step that requires them to invest in Information Therapy , but most patients are too lazy to do so.

One would think that it's easier to look for better options after you have experienced one IVF cycle , and burnt your fingers in the process. Ideally, you have learnt your lesson, and now know exactly what questions to ask , so you can find a better clinic .

However , most patients in India are still very fatalistic , and refuse to participate actively in their medical care. They take the attitude that the doctor knows best, and are happy to follow orders blindly.They believe that the known devil is better than the unknown one , and are not sure how to differentiate between a good clinic and a bad clinic.

After all, if they weren't able to select a good IVF clinic the first time , why they would be able to do a better job the second time around ? After failing an IVF cycle, they have low self-esteem , because the IVF doctor often blames them for the failure by saying things like - Your cycle failed because you have poor quality eggs, and you need donor egg IVF if you want to increase your chances of getting pregnant !

They have lost confidence in all IVF doctors , and think they are all equally incompetent.

The truth is that you have already paid expensive tuition fees in the form of the first failed IVF cycle , and in fact, you can do a much better job at finding a better IVF clinic, because you now know exactly what questions to ask !

If your cycle has failed, and your IVF doctor has not bothered to give you photos of your embryos, the first thing you should do is get a second opinion !

Need help 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 doesn't every embryo become a baby in every IVF cycle !

IVF patients have many unrealistic expectations. In their hunger for a baby, they often become desperate and start assuming that IVF is a panacea for infertility.

They naively assume that if the IVF clinics has made top quality generating embryos in the lab then this embryo will become a kid after it's implanted in the uterus !

This would make my life so much easier if it were true! Then all I'd have to do is tell patients to pay my fees so they could take their baby home with them!

Putting aside the jokes, we must recognise that the success rate of IVF is restricted not by medical technology, but by the biological fact that human reproduction is inefficient. Let's not forget that even the most fertile couple takes a long time to conceive in their bedroom. Even if they have intercourse every day, only approximately 20% of couples will become pregnant in a month. This is known as the fecundity rate, and we also know that nine out of ten couples will take up to a year to become pregnant in their bedroom, regardless of how often they have sex.

This is why infertility is defined as a couple's inability to become pregnant in their bedroom after at least a year of trying. Even fertile couples must be patient in order to become pregnant, and travelling to an IVF facility does not change this fact. Of course, being a patient in your bedroom is more easier and more enjoyable (and far less expensive!) than being a patient in an IVF facility, but you really don't have a choice.

This is because the rate limiting factor for IVF cycle success is not the clinical therapy we provide, but the fact that after we produce the embryo and put it back into the uterus, we have no influence over whether or not it will implant. This is due to the fact that embryo implantation is still a grey area that we can't monitor or regulate. We do know that most embryos do not develop into kids, whether they are created in the laboratory or in the bedroom (in vivo) ( in vitro). This is due to the fact that most embryos have random genetic mistakes. Some of these are fatal, which is why these embryos stop developing and stop growing. The difference is that this happens in the privacy of a woman's bedroom, and she is blissfully unconscious of the number of embryos that die in her uterus each month.

In fact, IVF has been shown to boost natural fertility rates. Nature's fertility rate is at 20%, but in an IVF cycle for patients who are good ovarian responders, we can boost it to 40% by assisting the lady in producing many eggs and selecting the finest blastocyst to transfer.

While we can regulate the process of superovulation and how we grow the embryos in the IVF lab, we have no control over what happens to the embryos when they are transferred back into the uterus.

This is aggravating for patients, as well as doctors, because we want all of our patients to become pregnant as soon as possible, and it hurts our hearts when they don't, despite our best efforts!

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 do doctors transfer dead embryos in an IVF cycle ?

When I see some of the scams that IVF clinics use to extract money from patients by preying on their ignorance and vulnerability, it breaks my heart. 

Some doctors will transfer dead embryos into the uterus, and when the cycle fails ( as it's bound to because dead embryos can't implant !), they lie and tell the patient that they've done everything humanly possible, and that IVF cycle failure is not in the doctor's hands.

While it's true that whether a top quality embryo will implant or not is not in the doctor's hands, whether the embryo the doctor makes in the IVF lab is of good quality or not definitely is !

IVF patients are extremely vulnerable, which is why it's critical that you find a doctor you can trust. However, you must ensure that the doctor earns your trust by being open, transparent, answerable, and accountable so that you are not taken for a ride. If you need assistance interpreting your embryo's photos, you can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos

So why do IVF doctors continue doing this kind of dirty, shady business ? 

They do so because they know they can get away with it !

They keep their patients ignorant, and they naively believe that once the doctor has done the transfer, he has provided them with the best medical care. That if the cycle fails, this was not because of medical incompetence, but because of their bad luck !

The cruel doctors add insult to injury . Not only do they waste their patient's money, they provide false hope and subject the patients to a huge emotional burden making them go through a pointless horrible two-week waiting period that will be completely futile because the embryo was dead .

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 !

Are you killing your own sperm ?

 

Infertile couples are frequently under-informed on basic biological realities, as a result of which they inadvertently reduce their own fertility, and therefore become infertile!

The usage of K-Y jelly during sexual intercourse is a common example of this.

Infertile couples are frequently urged to have sex as often as possible in order to increase their chances of becoming pregnant rapidly. Forced baby-making sex "on demand" is problematic, though, because the wife isn't fully lubricated, and sex might be painful for her. This is why lubricants are used to alleviate the superficial dyspareunia.

K-Y jelly is the most prevalent over-the-counter vaginal lubricant, and it's the one that most people use because it's convenient.

They are unaware, however, that K-Y jelly is sperm toxic and kills sperm. Because most pharmacists and doctors are unaware of this, these couples frequently continue to use K-Y Jelly for months while attempting to conceive. They have no idea that instead of increasing their chances of becoming pregnant, they are really decreasing them!

Unfortunately, this is one of the things they don't tell their doctors about, and most doctors have no idea that their patients use K-Y jelly as a lubricant.

The good news is that this is a simple problem to solve: when having baby-making sex, please do not use K-Y jelly!

If you do need to use a lubricant, the good news is that sperm-friendly lubricants are widely available, with liquid paraffin being the cheapest (and readily purchased at any pharmacist). Although liquid paraffin is commonly used as a laxative, it should not be consumed.

This is sperm-friendly, and it's the same chemical we use to grow and culture your embryos in the IVF lab.

Please remember to bring me a box of chocolates when you quit using K-Y jelly and start using liquid paraffin and become pregnant!

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 doesn't IVF have a 100% success rate ?

 

What can we do to make sure our IVF cycle will succeed ? This is a question many IVF patients ask. After all, if we are making embryos in the IVF lab, then shouldn't the embryo always become a baby  when we put it back into the uterus?

I wish this were true - it would make my life so much easier ! I would then just have to tell patients to pay my fees, so they could take home their baby with them!

Jokes apart, we need to understand that the IVF success rate is limited not by medical technology but by the basic biological fact that human reproduction is not very efficient. Let's not forget that even a very fertile couple takes quite some time to make a baby in their bedroom . Only about 20% of couples will get pregnant in one month , even if they have sex every single day . This is called the fecundity rate , and we also know that out of 10 couples , 9 will take up to one year in order to get pregnant in their  bedroom , no matter how frequently they have sex .

This is why the definition of infertility is restricted to couples who fail to get pregnant in their bedroom, even after trying for at least a year . The truth is that even fertile couples need to be patient in order to get pregnant , and going to an IVF clinic doesn't change that fact . Of course, it is far easier and much more fun ( and much less expensive !)  being patient in your bedroom as compared to being a patient in an IVF clinic , but either way , you really don't have a choice .

This is because the rate limiting factor for success in an IVF cycle is not the clinical treatment we provide , but the fact that after we make the embryo and then transfer it back into the uterus , we have no control over whether it's going to implant or not. This is because embryo implantation is still a black box area , which we can't monitor or control . We do know that most embryos do not become babies, whether they are made in the bedroom ( in vivo) or in the lab ( in vitro). This is because most embryos have genetic errors, and these are random . Some of these are lethal, which is why these embryos arrest and can't develop any further. The difference is that this is a silent process in the bedroom, and women are blissfully unaware of the number of embryos that die in their uterus every month. 

In fact, IVF actually increases the natural fertility rate . Nature's fertility rate is about 20% , and in an IVF cycle for patients who are good ovarian responders, we can increase this to 40% by helping the woman to grow many eggs, and selecting the best blastocyst to transfer.

However, while we can control the process of superovulation and how we grow the embryos in the IVF lab,  the fact remains that after we transfer the embryos back into the uterus, we have no control over what happens to them .

This is frustrating for patients - for doctors as well, because we want all our patients to get pregnant as quickly as possible, and it breaks our hearts when they don't, in spite of our best efforts  !

 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 !

 

The biggest risk IVF patients face today - and how you can protect yourself !

 

The biggest risk IVF patients face today is that they may get trapped into taking treatment in a bad IVF clinic.

These clinics will not only cheat you by providing poor quality treatment, thus failing to give you a baby , they will also empty your bank account ! And the second order consequence is that once you have had a bad experience at a bad IVF clinic , you aren't going to trust any other IVF clinic either.

Once you have burned your fingers, you refuse to believe that any clinic is any better than another , and this bad experience scars you for life . As a result, you refuse to try another IVF cycle at a better clinic, which means you reduce your chances of ever having a baby .

The good news is that you aren't helpless, and there's a lot you can do to prevent a bad IVF clinic from taking you for a ride .

However, you need to make sure that you don't get cheated before you start your IVF treatment rather than afterwards , because once you have paid your fees , there is no way you are going to get them back !

This is why it's so important to arm yourself with Information Therapy so you learn to ask the right questions before selecting an IVF clinic and starting your treatment.

You don't want to get trapped by taking treatment at a bad IVF clinic .

Ironically, it's the bad IVF clinics - those which are set up to maximize their profits rather than optimise their patient's pregnancy rates - which spend the most money on advertising - both online and offline ! They buy a high public profile , which is how they lure patients into their clinic - for example , by offering free consultations , or by holding IVF camps !

They know that patients are not well informed , and don't know how to judge the quality of an IVF clinic , so it's easy to trap them once they enter the clinic.

The good news is that you can protect yourself from being cheated by a bad IVF clinic , but this does require that you do a bit of homework .

By making sure that you ask the right questions before you part with your money , you reduce the chances of being cheated.

You don't need to become an IVF expert to learn to ask the right questions  - all you need to do is to speak up !

If the doctor refuses to answer your questions, this is a red flag, and you should run away asap !

When I review the medical records of patients who have failed IVF cycles in other clinic, it breaks my heart when I see how much money they have wasted on pointless tests like sperm DNA fragmentation , ERA ( endometrial receptivity assay) , and PGT ( preimplantation genetic testing) .

You can't afford to be lazy and just blindly assume that the IVF doctor you are going to is good , because this kind of misplaced trust can prove to be very expensive to you ! It's important to trust your doctor - but you also need to verify that he deserves your trust !

The time and energy your invest in Information Therapy will make a world of difference in ensuring that you go to a good IVF clinic , rather than a bad one who just wants to make money by exploiting your ignorance and vulnerability.

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 !

 

 

How the IVF Law can put IVF patients first !

I am relieved that the Indian government has finally realised the importance of regulating IVF clinics by passing the ART Bill.

While some IVF facilities are outstanding, a number of poor IVF clinics have popped up in recent years, and an IVF specialist seems to be on every street corner in most towns, promising high success rates!

Unfortunately, these practitioners lack the necessary experience and expertise to adequately deliver IVF treatment.

Typically, these clinics are administered by gynaecologists who have never performed an IVF cycle during their medical training. They do a one-week diploma or certificate course and hang out their shingle, ready to entice unsuspecting people, because they believe IVF is highly profitable.

Worse, the IVF labs in these clinics are supervised by technicians who aren't skilled embryologists, which means the embryos aren't cultured properly to Day 5. When they freeze the embryos, they frequently kill them, exacerbating an already terrible situation.

The difficulty is that because of the inadequate record-keeping and the refusal of many IVF facilities to provide medical records, patients are unable to ascertain why their IVF cycle failed.

Patients are unable to distinguish between a good IVF clinic and a bad IVF clinic, thus the legislation is a positive move in the right way, since it establishes the minimum equipment that an IVF facility must possess.

However, there is one crucial piece of information lacking from this Act. The government should have made patient education mandatory for all IVF clinics, not just in the form of counselling, but also by explicitly stating that the patient's IVF medical records are his or her property, and that the doctor is required by law to hand them over to the patient at the end of the IVF cycle. They should have additionally required that images of the transferred embryos be included in the records on a regular basis, so that patients have definitive verification of the quality of care they got. This is, by the way, a global procedure that all competent IVF centres follow on a regular basis.

This simple step would have been beneficial to patients since it would have given them greater confidence in the quality of care they would receive. It would also be beneficial for good IVF clinics to provide embryo photos on a regular basis, because they understand that the only thing an IVF clinic can do is produce high-quality embryos, and they are proud to do so because this transparency boosts patients' trust in the facility.

More crucially, because bad IVF clinics will not be able to comply with these requirements because they are incapable of creating excellent quality embryos, this single step will compel them to discontinue providing IVF therapy.

This one easy step would prioritise patients and assist all Indian IVF clinics in providing world-class levels of IVF care.

Do you require assistance in conceiving a child? Please fill out the form at www.drmalpani.com/free-second-opinion with your medical information so that I can assist you!

The semen analysis scam - why sperm test reports are unreliable

Despite the fact that a semen analysis is a simple , routine and affordable test, it is frequently performed incorrectly.

This is especially true when the test is performed in a local lab by an untrained technician who does not know how to correctly perform the sperm test. Because there is no quality control, he either uses antiquated equipment or takes shortcuts.

The true tragedy, however, is that semen analysis reporting in IVF labs is also notoriously unreliable and untrustworthy.

Most corporate IVF chains' labs appear to be incentivised these days to maximise the number of patients who seek treatment at the IVF clinic, rather than to give accurate and credible data! The semen analysis result is used to persuade patients to undergo IVF treatment, even if they don't require it!

The most prevalent deception is when an IVF lab declares most sperm samples to have teratozoospermia without properly inspecting sperm morphology. Because the sperm must be immobilised and stained, and the technician must examine at least 100 sperm before making this diagnosis, checking the form of sperm is a time-consuming and costly procedure.

The most typical shortcut (which many IVF facilities instruct the technician to use) is to register every sample as having teratozoospermia and state that there are less than 4% normal forms, with no evidence ( the images of the stained slide). This means that an IVF clinic lab can report whatever they want because there is no way of knowing whether they did the test correctly!

Unfortunately, due to a lack of quality control and regulation, the diagnosis of male factor infertility due to teratozoospermia is becoming epidemic. Many individuals are misdiagnosed with male factor infertility and told they need to start an IVF treatment cycle, while the truth is that it's just a faulty lab report.

Unfortunately, patients believe that because the report is generated by a specialised IVF lab, it must be accurate, and they are unaware that they are being duped.

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 !

How to find out why your IVF cycle failed - a guide for intelligent IVF patients

One major problem with IVF today is the fact that the chances of an individual IVF cycle failing are always higher than that of its succeeding.

What makes this so complex is that there are multiple reasons for IVF failure , and it's not easy to sort out what the reason in your particular case was.

It's helpful to use the following simplification when trying to figure out what to do after your IVF cycle fails.

You basically need to figure out if the cause of the failure was something that is out of your hands , or something that can be corrected .

For example, if the reason for the failure was poor quality embryos because of diminished ovarian reserve , then this is a biological constraint for which doctors don't have an effective solution. One the the other hand , if the reason for the failure is a bad IVF clinic which transferred embryos on Day 2 or Day 3 and didn't even bother to provide you with photos of your embryos, then this suggest this is a very correctable problem , and all you really need to do is to change your doctor and find a better clinic - one which will provide embryo photos and do only blastocyst transfers.

This is why it's so important that IVF patients learn to analyse the treatment they are receiving, and the right time to do this is actually before you start your IVF cycle , so that you can ask your doctor intelligent questions , and make sure that you are getting world-class medical care , rather than finding out only after the cycle has failed that you got cheated and the doctor short-changed you by not following Global best practices .

The good news is that often the reason for the IVF failure is a bad IVF clinic, and a better IVF doctor can easily correct this.

Therefore there is no reason to get disheartened just because your IVF cycle fails . All it means is that you need to invest in Information Therapy , so you can become a well-informed patient . Not only will this reduce your chances of your first IVF cycle failing, it will also increase the chances of your second IVF cycle succeeding !

IVF treatment is too important to leave up to the doctor, and that's why you need to be an actively involved patient, because there is so much at stake. 

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 !

Don't let your IVF clinic take you for a ride by hiding the truth from you !

IVF treatment is shrouded in mystery because it looks to be a time-consuming and costly procedure that includes numerous injections and clinic visits.

This is due in part to the mystery around how IVF is performed and what the outcome will be. People become confused as a result of this, and IVF professionals contribute to this by not being transparent. They are unwilling to share their knowledge with patients, and it appears that clinics believe it is in their best interests to make the process as complicated and difficult as possible in order to charge a higher fee! Even worse, they hide what's happening to your embryos in the IVF lab, so you are completely in the dark !

The truth is that IVF is a straightforward procedure. Yes, it takes a lot of skill to execute it correctly, but it's conceptually simple since all we're doing is reproducing what's not happening in the bedroom for infertile couples by developing embryos in the lab.

It's easy to divide the procedure into four stages: superovulation, egg harvesting, IVF and embryo culture, and lastly embryo transfer.

There's no reason why every patient shouldn't know what's going on during each stage of the IVF cycle; in fact, a treatment plan should be shared with patients ahead of time so they know what to expect. Don't let a doctor take advantage of information asymmetry !

Good doctors keep their patients updated on their progress on a daily basis so they are aware of what is going on. Because patients feel in control, their anxiety levels reduce dramatically as a result of this transparency.

Doctors continue to get away with making what should be a simple process extremely difficult, partly because they want to maintain their aura of superior professional expertise, and partly because patients are unwilling to take the time and trouble to apply their intelligence to understand what is going on!

This is also why many IVF doctors get away with performing a big number of expensive, entirely unneeded tests on all of their patients on a regular basis, which don't enhance pregnancy rates but help them make a lot of money! Unfortunately, patients are unaware that they are being taken for a ride!

Information Therapy is the only way to solve this problem, which is why our free IVF comic book (https://www.drmalpani.com/knowledge-center/resources/books/ivf-comic-book) is so useful.

Do you require assistance in conceiving a child? Please fill out the form at www.drmalpani.com/free-second-opinion with your medical information so that I can assist you!

Are you reducing your own fertility by using a sperm killer when having sex ?

 

Infertile couples are often poorly informed about basic biological facts of life , as a result of which they inadvertently end up reducing their own fertility , and end up making themselves infertile !

A common example of this is the use of K-Y jelly during sexual intercourse .

Often, infertile couples are advised to have sex as frequently as possible to maximize their chances of getting pregnant quickly. However, being forced to have baby making sex "on demand" is difficult, because the wife is not adequately lubricated , and sex can become painful for her. This is why they resort to using lubricants to reduce the superficial dyspareunia.

The most common vaginal lubricant available over the counter is K-Y jelly, and this is the one most end up using ,because it's easily available .

However, they don't realise that K-Y jelly is sperm toxic , and kills sperm. This is not something most pharmacists and doctors are aware of either, as a result of which these couples often continue using K-Y Jelly for many months , while trying to have sex in order to get pregnant . They are blissfully unaware of the fact that instead of improving their chances of getting pregnant , they are actually reducing them !

Unfortunately, this is one of the things they often don't share with the doctor , and most doctors aren't aware that their patients are using K-Y jelly as a lubricant .

The good news is that this is an easy problem to solve - please stop using K-Y jelly when having baby-making sex !

If you do need to use a lubricant , the good news is that sperm friendly lubricants are easily available , and the cheapest one ( which is easily available at any chemist ) is liquid paraffin . Liquid paraffin is normally used as a laxative , but please don't drink it !

This is sperm-friendly, and is the same chemical we use in the IVF lab when growing and culturing your embryos.

When you stop using K-Y jelly and start using liquid paraffin and get pregnant , please don't forget to send me a box of chocolates !

 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 !

 

 

How the Indian IVF Law can put IVF Patients First !

 

I am very glad the Government of India has finally woken up and decided to regulate IVF clinics by passing the ART Bill .

While some IVF clinics are excellent, a number of shoddy IVF clinics have cropped up in the last few years , and every street corner in most towns seems to have an IVF specialist who promises high success rates !

Sadly, these doctors don't have the required experience and expertise to be able to provide IVF treatment properly .

These clinics are usually run by gynecologists who have never done a single IVF cycle during their medical training. Because they think IVF is highly profitable, they do a one-week diploma or certificate course, and hang out their shingle, ready to attract unwary patients.

Even worse, the IVF Labs in these clinics are run by technicians who aren't expert embryologists, as a result of which they aren't able to culture the embryos properly to Day 5. They often kill the embryos when freezing them, thus making a bad situation even worse.

The problem is that because the documentation is so poor, and because these IVF clinics refuse to share medical records, it's impossible for patients to determine the reason why their IVF cycle failed.

Patients are not in a position to be able to judge the difference between a good IVF clinic and a bad IVF clinic , so the regulation is definitely a step in the right direction , because it lays down the minimum equipment an IVF clinic needs to have.

However, an one important piece of information is missing in this Act. The Government should have made patient education compulsory for all IVF clinics, not just in the form of counselling , but also of explicitly saying that the patient's IVF medical records are the property of the patient , and the doctor needs by law to hand over the medical records at the end of the IVF cycle to the patient . They should also have specified that the records should always routinely  include photos of the transferred embryos, so that patients have documentary tangible evidence of the quality of the care they have received. Incidentally, this is a global practice which all good IVF clinics all over the world routinely follow.

This simple step would have been great for patients , because then they could have had much more confidence in the quality of care they would have received . It would also be good for good IVF clinics , which routinely provide embryo photos currently, because they know that the only thing an IVF clinic can do is produce good quality embryos, and they are proud to do this, because this transparency increases the trust patients have in the clinic.

More importantly, this simple step would ensure that the bad IVF clinics will be forced to stop providing IVF treatment , because they will not be able to comply with these regulations , because they aren't capable of producing good quality embryos.

This one simple step would put patients first , and helps the quality of IVF care in all Indian IVF clinics  to become world class 

 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 you shouldn't trust your semen analysis report

There are many problems which plague semen analysis today.

Even though it's such a simple and inexpensive test , the truth is that it's is usually done extremely badly .

This is true when it's done at the local lab, where the technician is untrained, and does not understand how to do the sperm test properly . He either uses outdated equipment , or takes short cuts because there is no quality control.

However, the real tragedy is that the reporting of semen analysis in IVF labs is extremely unreliable and untrustworthy.

The labs of most corporate IVF chains these days seem to be incentivised not to provide accurate and reliable reports,  but to maximize the number of patients who take treatment at the IVF clinic ! The semen analysis report is used as a tool to drive patients to do IVF, even if they don't really need it!

The commonest racket is that the IVF lab reports most semen samples as having teratozoospermia , without actually checking sperm morphology . Checking the shape of sperm is a complicated and expensive exercise , because the sperm need to be immobilized and stained , and the technician needs to check at least 100 sperm before making this diagnosis .

The commonest shortcut ( which many IVF clinics tell the technician to do ) is to record every sample as having teratozoospermia , and to report that there are less than 4% normal forms , without providing any documentation ( the images of the stained slide). This means it's possible for an IVF clinic lab to report anything they want , because there is no way of testing whether they have done the test properly !

Unfortunately , because there is no quality control or regulation , this diagnosis of male factor infertility because of teratozoospermia is becoming an epidemic . Many patients are labelled as having male factor infertility , and are advised to do an IVF treatment cycle , when the reality is that it is actually just an incorrect lab report .

Sadly, patients feel that it because the report is being done by a specialty IVF lab , it must be reliable , and they don't even realise that they are being taken for a ride.

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 !

How IVF specialists make the easy process of IVF hard

IVF treatment is surrounded by a lot of mystique because it appears to be a complex process that is expensive , because it involves a lot of injections and visits to the clinic .

The reason for this is partly because of the uncertainty around how IVF is done , and what the outcome is going to be. This creates confusion in the minds of people , and IVF specialists contribute to this by not being transparent . They are not willing to share their knowledge with patients , and it seems that clinics believe that it's in their best interests to make the process as complex and difficult as possible, as this gives them the ability to charge a lot more for it !

The reality is that IVF is a simple process . Yes, there is considerable expertise involved in being able to do it well , but conceptually it is extremely easy to understand , because all we are doing is replicating what is not happening in the bedroom for the infertile couple by creating embryos in the laboratory .

It's simple to break up the process into 4 phases: - superovulation ; egg retrieval ; in vitro fertilization and embryo culture; and finally embryo transfer .

There is absolutely no reason why every patient should not know exactly what is happening during each part of the IVF cycle, and in fact, a treatment plan should be shared in advance, so patients know exactly what to expect.

Good doctors share details of exactly what's happening during the treatment with the patient , so they know what's  going on and how their cycle is progressing. This transparency engenders trust, and because patients feel in control, their anxiety levels drop a lot !

It's partly because doctors want to retain their aura of superior professional expertise , and partly because patients aren't willing to take the time and trouble to apply their intelligence to understand what is happening , that doctors continue to get away with making what is a simple process extremely hard !

This is also why so many IVF doctors get away with doing a large number of very expensive , completely unnecessary tests routinely for all their patients, which don't improve pregnancy rates , but help them make a lot of money ! Sadly, patients don't even understand that they are being taken for a ride !

The only solution to this problem is Information Therapy , which is why our free IVF comic book at https://www.drmalpani.com/knowledge-center/resources/books/ivf-comic-book is so helpful

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 !

Using fresh donor eggs is dangerous !

Because we know that fresh sperm increases the risk of HIV transmission, it's now normal practise all over the world to utilise only frozen sperm for donor insemination.

Although this is also true for donor eggs, we continue to use fresh eggs from fresh donors. This is, however, utterly inappropriate, especially now that egg freezing technology has advanced so far. When eggs are vitrified in a good facility with an experienced embryologist who has the needed competence, the survival percentage is 100 percent.

To avoid the unintended transmission of HIV/AIDS through IVF, we should ensure that the only eggs used for donor egg IVF are frozen eggs, just as we do with frozen sperm samples.

Not only are frozen eggs safer, but they also have a greater conception rate. It's more safer to use frozen eggs because we know how many there are and can ensure that at least 10 mature eggs will be available for the recipient.

When we use frozen eggs, we don't have to worry about synchronising their cycles, which makes it much easier to match the physical characteristics of the egg donor and the receiver.

The good news is that thanks to the technology of vitrification ( ultra-rapid freezing), in our clinic, the survival rate after thawing frozen embryos is 100%.

Sadly, most IVF clinics don't have expert and experienced embryologists, which is why they are scared to offer this option.

Do you want to learn more? Fill out the form at www.drmalpani.com/free-second-opinion to email me your medical information so that I can assist you !

We specialise in treating patients who have failed IVF treatment in other clinics

Most IVF clinics prefer to treat patients who are starting their first IVF cycle because they are the people with the best chances of becoming pregnant. Most clinics avoid treating patients who have previously failed an IVF cycle because the fact that they failed in another clinic means that their chances of getting pregnant in their second cycle are lower than someone who is doing their first cycle, and they frequently have an underlying medical problem that is difficult to treat.

However, we prefer to treat people who have had a failed IVF cycle at another facility. For one thing, they know precisely what to expect because they've been through a cycle before. Because they've already experienced failure, they have realistic expectations for IVF treatment. They've learned the hard way that a single IVF cycle's success rate will never be 100 percent. They understand that all an IVF doctor can do is focus on the process and ensure that the therapy is done correctly, because the final outcome is out of their control.

Because they're more informed, these patients are a lot more enjoyable to treat. They ask thoughtful questions that keep us on our toes because they've done their homework. This aids in the enhancement of the care we deliver. They also serve as a standard for us, allowing us to compare and contrast our practises with what they've done in the past.

Finally, and most importantly, they understand why we are superior to other clinics. Patients who are doing their first IVF cycle with us can tell that we are good doctors, but they have no benchmarks to compare us to. Someone who has gone through an IVF cycle elsewhere, on the other hand, understands how much nicer and superior we are. We don't keep people waiting for long periods of time, and we don't have any assistance, so we're really hands-on. We make all of our own decisions, which allows us to tailor the therapy procedure to each patient's unique situation. We're really upfront and transparent with them, and we treat them like responsible adults. We are nonjudgmental and respectful of their own needs and wishes, allowing them to feel empowered and in command.

We make them a treatment plan so they know what to expect, and we've developed applications and educational materials to help them better manage their IVF cycle. Finally, we consistently showed them images of their embryos so they could see exactly what was going on and be certain that they were receiving the best possible treatment.

Only once you've experienced the standard of care at a typical IVF clinic can you realise how unique and wonderful we are!

Failed an IVF cycle ? Please fill out the form at www.drmalpani.com/free-second-opinion with your medical information so that I can assist you!

When should you change your IVF clinic after a failed IVF cycle ?

 

One major problem with IVF today is the fact that the chances of an individual IVF cycle failing are always higher than that of its succeeding.

What makes this so complex is that there are multiple reasons for IVF failure , and it's not easy to sort out what the reason in your particular case was.

It's helpful to use the following simplification when trying to figure out what to do after your IVF cycle fails.

You basically need to figure out if the cause of the failure was something that is out of your hands , or something that can be corrected .

For example, if the reason for the failure was poor quality embryos because of diminished ovarian reserve , then this is a biological constraint for which doctors don't have an effective solution. One the the other hand , if the reason for the failure is a bad IVF clinic which transferred embryos on Day 2 or Day 3 and didn't even bother to provide you with photos of your embryos, then this suggest this is a very correctable problem , and all you really need to do is to change your doctor and find a better clinic - one which will provide embryo photos and do only blastocyst transfers.

This is why it's so important that IVF patients learn to analyse the treatment they are receiving, and the right time to do this is actually before you start your IVF cycle , so that you can ask your doctor intelligent questions , and make sure that you are getting world-class medical care , rather than finding out only after the cycle has failed that you got cheated and the doctor short-changed you by not following Global best practices .

The good news is that often the reason for the IVF failure is a bad IVF clinic, and a better IVF doctor can easily correct this.

Therefore there is no reason to get disheartened just because your IVF cycle fails . All it means is that you need to invest in Information Therapy , so you can become a well-informed patient . Not only will this reduce your chances of your first IVF cycle failing, it will also increase the chances of your second IVF cycle succeeding !

IVF treatment is too important to leave up to the doctor, and that's why you need to be an actively involved patient, because there is so much at stake.

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 !

How to find out why your IVF cycle failed

 

As an IVF specialist, I review the medical records of many patients who have failed IVF cycles in other clinics.

The tragedy of Indian IVF is that the quality of care that most IVF clinics provide isn't good.

This is because gynaecologists get zero exposure to the practise of IVF during their postgraduate MD medical training. When they pass out of medical college, they attend a one-week IVF course and then set themselves up as IVF specialists because IVF treatment is remunerative, and it's considered prestigious to be an "IVF specialist".

The reason they continue getting away with this is because patients aren't sophisticated enough to be able to differentiate between a well-trained IVF doctor and one who has no idea about what they are doing .

There are multiple red flags which an IVF  specialist can easily detect when going through IVF medical records which suggest the quality of care was suboptimal, but I understand that patients aren't medical experts .

This is why they need to use this simple rule of thumb to decide whether the clinic you select for your IVF treatment is capable of providing quality care.

The beauty is that this is a simple question, and you can easily get an answer, even from the nurse or the receptionist in the clinic, by phone or by email, before actually visiting the clinic.

There is absolutely no excuse for IVF patients not to ask this question when choosing a clinic, and if patients don't do this, they only have themselves to blame if they end up going to a bad IVF clinic, which causes their IVF cycle to fail.

Here is the question:

Do you only do blastocyst transfers for all your patients and do you provide photos of the blastocysts routinely to all your patients?

Remember that the only tangible deliverable that an IVF clinic can provide is an embryo. This is the core expertise of an IVF clinic. After all, once the embryo has been transferred into the uterus, we have no control over whether it will implant or not, because embryo implantation is still a black box.

However, if the clinic has produced good quality embryos, this confirms that the clinician has superovulated you well and done the egg retrieval properly, and that the embryologist has nurtured your embryos safely in the IVF lab.

This is why all good IVF clinics all over the world routinely and proactively provide embryo photos to all their patients. Patients don't even need to ask for this-this is part of their medical record.

If your cycle has failed, the first step is to review your medical records and ask for a second opinion. If the clinic hasn't provided you with photos of your embryos, this clearly means you are in a bad clinic, and your best option would be to find a better clinic !

On the other hand, if your clinic doesn't give you photos of your blastocyst, this suggests that there is a problem with the quality of care they are providing, because there is absolutely no reason for a good clinic to hide this information. The photos document that they have provided good quality care—something that all good IVF clinics are proud of doing, because it bolsters their reputation and gives patients confidence that they are on the right track.

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 !

The one thing all IVF patients can do to maximise their chances of getting pregnant

We all know that IVF doesn't have a 100% success rate.

Because it's a biological system, there are many variables that will influence your chances of getting pregnant.

There are some which you can't do much about . For example, if you are older and have poor ovarian reserve , the limiting factor is going to be the quality of your eggs, as a result of which your embryos aren't likely to be top quality , and the chances of their implanting are going to be poor. Unfortunately , this is a fact of life you will have to learn to live with because we can't make you any younger .

The good news is that there is one important variable that you can influence to increase your chances of getting pregnant, and that is finding the right IVF doctor.

This is critically important, because this is the one thing in the entire IVF treatment that is completely in your hands.

It's up to you to select the right IVF doctor, and choosing the right doctor can make a world of a difference to your IVF success rates and your chances of getting pregnant.

You can't afford to leave this up to chance, and you can't afford to assume that all doctors are equally good.

You can't afford to remain ignorant about what a good IVF clinic is supposed to deliver in the form of treatment.

The good news is that finding the best IVF clinic is extremely simple - you don't need to become an IVF expert to find the best IVF expert!

All you need to do is find an IVF clinic that provides embryo photos routinely to all their patients and that does only blastocyst transfers. This is a simple way you can maximise your chances of getting pregnant without leaving everything to chance.

If you don't do your homework, you risk ending up in a bad IVF clinic. Not only will you end up wasting a lot of time and money, you will end up reducing your chances of getting pregnant as well!

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 !