How to Improve your chances of IVF Success?

There are several factors that can affect the success in vitro fertilization IVF and specific steps you can take to improve your chances would depend on your individual situation.

Some general tips for increasing your chances of success with IVF include:

1. Optimizing your overall health, Maintaining a healthy weight,  Eating a balanced diet and Being well informed about the treatment will help you reduce your stress levels. These can all improve your chances of successful IVF

2. Choosing an experienced Fertility Clinic -

The success rates of different fertility clinics vary.f so it's important to choose one with a good track record. find the clinic which does only blastocyst transfer and provide photos of Embryos to all their patients 

3. Timing your treatment -

Your fertility specialist will be able to advise you on the best time to undergo IVF based on your individual situation. Don't wait until you're too old, because egg quality declines with age, and poor ovarian reserve is the most common reason for IVF failure today, even when done in a good clinic.

4. Sticking to the treatment plan -

It's important to follow your fertility Specialist's instructions and attend all schedule appointments to increase your chances of success.

It's also worth keeping in mind that it is not always successful, and you may need to try more than once to achieve a successful pregnancy. It can be helpful to discuss your options and expectations with your Fertility specialist.

Need help getting pregnant? We provide a free second opinion for all infertility issues.

Visit our website at www.drmalpani.com to know more.

Please make sure that your IVF clinic has a full time embryologist

Many IVF clinics continue taking patients for a ride by cutting corners . While the ambience of the clinic maybe 5 star and the clinic may look very posh, with lots of patients and plenty of staff members, the reality is that the heart of the IVF clinic is the IVF laboratory , and the most important person in the IVF treatment is the embryologist , who actually does all the hard work behind the scenes in the lab to transform your eggs and sperms into embryos which the doctor can then transfer into your uterus so that they can become a baby .

If the embryologist is not good enough , you are not going to be able to get good quality embryos , as a result of which the IVF cycle will fail . The problem is that most patients are very poorly informed about the intricacies of IVF treatment , and they never ask this basic question to the doctor – Do you have a full-time embryologist ?

Now, it’s not possible for an IVF clinic to deliver high pregnancy rates without a full-time qualified , experienced and expert embryologist , because it’s his job to make sure that your eggs and sperms and embryos are cultured properly , and this is a full-time job , which can't be outsourced or done on a part-time basis .

Unfortunately, because there aren’t that many good quality embryologists available in the country , many IVF clinics take a shortcut and will hire a travelling embryologist to do IVF cycles for them in batches . While this maybe great for the clinic , because it helps them to earn more money , because they can now offer IVF treatment without having to employ a full-time embryologist ( who is an expensive resource) , this also means that their patients suffer, because their pregnancy rates are much lower .

A travelling embryologist doesn't have any long-term interest in making sure that the quality of the IVF lab is good , because he is not responsible for maintenance of the equipment . He can’t do any quality control , or troubleshooting, and if things don’t go well, he can blame the IVF clinic for not maintaining their equipment properly, while the doctor blames the embryologist for doing a bad job – but it’s the poor patient who ends up paying the price !

The travelling embryologist just comes in for a few days, does the procedures he is paid to do, and leaves without ever meeting the patient, or caring about what the final outcome was. This is why clinics without a full-time embryologist are not able to do day 5 transfers; are not able to provide embryo photographs to their patients; and are not able to freeze embryos efficiently for their patients , because the embryologist has left and moved on to do the procedures at some other clinic to earn more money for himself.

Because patients are ignorant and gullible, these clinics continue taking advantage of them by taking them for a ride. In our clinic, our embryologist, Dr Sai, talks to all our patients, and knows each of them, and each of them knows him !

This is why, before you start an IVF cycle, you should make sure that the clinic does only blastocyst transfer; that it provides photographs of embryos to all patients ; and has a full-time embryologist. Please make it a point to speak to the embryologist before you pay your fees, so you can judge competent , caring and expert he is.

Just like you need to ensure that you are in good hands because your doctor is a trusted expert , your need to ensure your eggs, sperm and embryos are in good hands as well, because the embryologist is an expert , and knows what he is doing .

Why you should freeze all your embryos when doing IVF

 

The reason freeze-all IVF cycles have become so popular is because it increases pregnancy rates , by allowing patients to have their cake and eat it too.

In the past . we would do only fresh cycles and fresh transfers , which means the embryos were transferred back in the same cycle in which the egg collection was done.

The reason for this was that the technology for freezing embryos wasn't very good , and many embryos would die during the freezing and thawing process. Today, however, we are very confident about offering this option routinely to all our patients , thanks to the technology of vitrification or flash freezing , where the survival rate of frozen embryos after thawing is 100% in good labs .

This strategy has lots of advantages .

For one thing, we can transfer only one embryo at a time , because we can store the rest safely. This improves the cumulative conception rate without incurring the risk of a multiple pregnancy , which often ends up as a preterm birth because the uterus wasn’t designed to hold more than one baby at a time !

This means that patients can have as many babies as they want - but one at a time , which is the right way to have babies , because twin pregnancies have a much higher risk of preterm births, and these premature babies often end up with multiple complications ( and also run up a huge bill during their NICU stay).

We can also optimise our superovulation strategy during the fresh cycle, and help the patient to grow many eggs, so we get lots of embryos. Because we are not doing a fresh transfer, the risk of OHSS( ovarian hyperstimulation syndrome, which can be a life-threatening complication) ) is nearly zero, and we can go ahead and freeze all the embryos. This is why, when we do a fresh cycle, our focus is on helping you to grow many eggs. However, the price we pay for this is that endometrial receptivity is compromised,  which is why the pregnancy rate in a fresh cycle is not very good , and this is the reason we prefer not transferring fresh embryos.

On the other hand , when we freeze all the embryos and then transfer them in the next cycle after thawing them one as a time, we can focus only on growing the endometrium in the thaw cycle, so that it’s receptivity is optimal. During this cycle, we don’t need to grow eggs, which is why this thaw cycle is much easier and less expensive, because no injections are needed.

This combined option ( freeze all embryos at the blastocyst stage in the fresh cycle and then thaw them and transfer them one at a time) increases pregnancy rates,  because it allows us to grow lots of embryos, and transferring them one at a time reduces the risk of multiple pregnancies and increases live birth rates. You should ensure that all your embryos are frozen only on Day 5; and that the clinic has a full-time embryologist, who will provide you with photos of your embryos, both before freezing them, and after thawing them

How to improve your chances of IVF success

There are several factors that can affect the success of in vitro fertilization (IVF), and the specific steps you can take to improve your chances will depend on your individual situation.

Some general tips for increasing your chances of success with IVF include:

Optimizing your overall health: Maintaining a healthy weight, eating a balanced diet, and being well-informed about the treatment will help you reduce your stress levels. These can all improve your chances of successful IVF.

Choosing an experienced fertility clinic: The success rates of different fertility clinics can vary, so it's important to choose one with a good track record. Find a clinic which does only blastocyst transfers and provides embryo photos routinely to all their patients. 

You can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos

Read more at https://blog.drmalpani.com/2021/03/how-to-check-on-your-ivf-doctor-so-you.html

Timing your treatment: Your fertility specialist will be able to advise you on the best time to undergo IVF based on your individual situation. Don't wait until you are too old, because your egg quality declines with age, and poor ovarian reserve is the commonest reason for IVF failure today, when the IVF is done in a good clinic.

Sticking to the treatment plan: It's important to follow your fertility specialist's instructions and attend all scheduled appointments to increase your chances of success.

It's also worth keeping in mind that IVF is not always successful, and you may need to try more than once to achieve a successful pregnancy. It can be helpful to discuss your options and expectations with your fertility specialist.

You can download the IVF Comic Book free at www.drmalpani.com/IVFComicBook 

How can you know if your frozen embryos are alive after thawing and are ready to be transferred?

Saiprasad Gundeti, Chief Embryologist, Malpani Infertility Clinic

In IVF treatment, we freeze/ cryopreserve your spare Embryos after your Embryo Transfer to store them as a backup in case your first cycle is unsuccessful, or we freeze all of your Embryos owing to the risk of ovarian Hyperstimulation Syndrome (OHSS) or if the lining is not optimal .

For subsequent frozen embryo transfer cycles, your frozen embryos must be thawed prior to transfer.

Patients typically have lots of questions and are concerned about the viability of their embryos upon thawing.

How can one know if the embryos have survived post thawing and are ready to be transferred?

At Malpani Infertility Clinic, we culture fresh embryos till day 5 and transfer or freeze embryos at the blastocyst stage for all of our patients.

You can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos

This allows us to select the best embryos for transfer and freezing, increasing your chances of becoming pregnant.

When we freeze Blastocysts on Day 5/Day 6, we put Laser Pulse between the Trophectoderm Cells to artificially collapse them. This reduces the amount of water that must be replaced during vitrification, as well as the duration that embryos are exposed to Vitrification solutions (cryoprotectants), hence decreasing the toxicity of cryoprotectants.

Therefore, when we vitrify (freeze) your Blastocyst, it will be in a collapsed (reduced) state.

For Frozen Embryo Transfer (FET), when we thaw your frozen blastocyst prior to the transfer, it will be in a collapsed state; however, after a few hours of incubation, the thawed blastocyst re-expands.

The re expansion of the blastocyst provides confidence that it has survived and is ready for transfer.

We at Malpani Infertility Clinic often thaw blastocysts three hours ahead of the transfer, which provides sufficient incubation time and re-expansion of the blastocyst prior to transfer. 

We routinely show our patients their embryos before transferring them and explain how their embryos recovered after freezing and thawing, which makes them happy and gives them confidence that their embryos have recovered well from the freezing process and are ready for transfer.         

Need help in making the right decision ?

Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Why do bad IVF clinics refuse to give embryo photos routinely to all their patients ?

There are 3 important reasons you should demand photos of your embryos from your IVF clinic

1. This is a global best practice , which all leading IVF clinics all over the world follow , because this allows them to document that they generated top quality embryos. This is invaluable diagnostic and prognostic information as well ! If they did produce top quality blastocysts for you, then you know that your chances of getting pregnant over a period of time are excellent , and you just need to be patient ! However, if you don't have any photographs , this is valuable information that was wasted because of the lack of photos. If your clinic refuses to provide photographs , you have to ask yourself why they are hiding information from you ! All modern IVF labs have cameras attached to their microscopes,  and taking photographs does not harm the embryos at all , which is why we good clinics do this routinely for all their patients.

2. This practise is good for the patient because it proves to them that they received top quality medical care . The fact that the doctor made top quality blastocysts for them increases their trust and confidence in him. Much more importantly, they have peace of mind knowing that they have received the best possible medical care , and didn't leave any stone unturned in their quest for a baby. The outcome maybe uncertain, but embryo photos prove the process was carried out properly !

3. It's also good for the doctor to provide embryo photographs , because good doctors take pride in the high quality of care they provide . If they can provide photos of top quality blastocysts, this confirms that they are competent professionals who are doing a good job for their patients . This is great for the doctor’s reputation as well, because patients will often get a second opinion when their IVF cycle fails, and if the new specialist can see that the first doctor created top quality blastocysts, they can vouch for the fact that good quality medical care was provided , irrespective of the final outcome.

You can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos

Why Batch IVF has a lower pregnancy rate

 

Now that every gynecologist wants to become an IVF specialist ( because this is considered to be high-profile and profitable) , many gynecologists have started doing IVF in their own clinics. However, because they don't have either the confidence , expertise, competence or experience of doing this, they need to hire an IVF specialist to do the actual medical treatment for their patients.

This is why they do batched IVF . They cycle a group of patients together - usually 5 to 25, depending on how greedy they are. The medical experts who do the IVF treatment then fly down for 1-2 days to actually do the procedures. The gynecologists claims that the success rate for batch IVF is as good as regular IVF, and that this option is much more convenient for patients . who don't need to travel and much less expensive as well. Most patients are also happy with this option , because they prefer taking treatment from a trusted local doctor .

However, the reality is that this is a bad idea because the success rate of batched IVF is terrible, and there are many reasons for this .

For one thing , these gynecologists are not IVF specialists, and are doing this just in order make more money . They often end up having to take shortcuts,  which compromise pregnancy rates.

For example , they are not able to do Day 5 transfers , because the embryologist has left , and they end up transferring many Day 2 and Day 3 embryos, to try to compensate for this. They aren’t able to freeze embryos, because the embryologist is too busy doing ICSI, and doesn't have the time to do this. They end up doing too many cases in one day , because the travelling embryologist and IVF specialist want to maximize their income , which means they have to complete one pick up and transfer in about 10 minutes. The scope for mix-ups and mistakes is much higher in this chaotic setting. All patients end up having their pickups and transfers done on the same day , even if they aren’t medically ready. The doctor is not able to customise the treatment protocol for each patient , because they have to use the same treatment plan for every patient, based on what the IVF specialist tells them . This expert is remote, and has never seen the patient , and really doesn't care about what happens to you.

This is also why the documentation in these clinics is so poor, because the staff doesn't have the time or the energy to take photos of the embryos.

The medical equipment is also not maintained properly, because it is used for only a few days in a month, as a result of which the lab often isn’t able to create good quality embryos, but it’s easy to pass the buck, and the IVF specialist blames the local gynecologist, who blames the specialist, but it’s the poor patient who ends up suffering.

Finally, many of the “extra” eggs and embryos created during these batches are “donated” to other patients, without their permission, knowledge or consent ! This has now become illegal under the new ART Act, but this practice continues merrily nevertheless !

Should you freeze your eggs ?

 

Many young women freeze their eggs as an insurance policy , because it allows them to delay having children until they are ready to have a baby.

Some are unsure if it’s right for them as egg freezing is expensive and invasive. Determining whether freezing your eggs is worth the expense can be tricky.

So, should you freeze your eggs? Ultimately, it’s your decision, but here’s what we do know.

Step-By-Step Egg Freezing

Here is what the journey looks like:

1. Go to a fertility clinic for a set of fertility tests to test your ovarian reserve. These include an AMH level ( read more at http://www.drmalpani.com/knowledge-center/infertility-testing/amh) and an antral follicle count ( read more at http://www.drmalpani.com/knowledge-center/articles/afc)
2. Hormone stimulation – daily hormone injections for about 7-10 days to stimulate the production of eggs in the ovaries. You self-inject using a small needle at home, usually into the thigh or tummy. These are safe and effective, because they are natural hormones, and get excreted promptly in the urine.
3. Monitoring – your ovaries are monitored throughout the hormone stimulation, using transvaginal ultrasound to check the development of eggs and time the collection procedure. You need to come to the clinic about 3-4 times
4. Egg Collection – A probe is inserted into the vagina, with a needle piercing through the vaginal wall and into the ovary to "suck out" eggs from the ovary. This is painless because it’s done under anesthesia and takes a few minutes. The eggs are then cryogenically frozen using vitrification technology.

Does It Work?

You’re probably wondering, how likely is egg collection and freezing to be successful? This depends. The age at which you freeze (the younger the better), the number of eggs you freeze, and the expertise of the clinic are all factors that impact how likely you are to have a baby if you need to use your frozen eggs in future. One thing is for certain, it’s not a guarantee.

Is It Worth It?

Some women who have frozen their eggs can go on to conceive naturally. However, despite not needing to use them, the vast majority of women reported having no regrets over their decision to freeze and nearly everyone said they would recommend it to a friend because the peace of mind it provides is invaluable,

 It’s an incredibly personal decision and no one can tell you what is right for you – you need to decide for yourself !

 

 

 

How getting older affects fertility and pregnancy: Having a baby after 35

When are women most fertile during their life?

The best time for a woman to have children is between her late teens and late 20s. Fertility, or the ability to have children, starts to go down after age 30. When you reach the middle of your 30s, this decline speeds up. By the time a woman is 45, her fertility has dropped so much that it is unlikely that she will get pregnant on her own.

Why does fertility decline as you get older ? This is because  a woman has a set number of eggs in her ovaries at birth, and she does not produce any new eggs in her lifetime. As a woman gets older, she has less eggs because her eggs start running out with each menstrual cycle. Also, older women are more likely to have eggs that have chromosomes that aren't right because they have aged.  Also, as women get older, they are more likely to get diseases like fibroids and endometriosis that can make it hard for them to get pregnant. Incidentally , a man’s fertility is not affected by his age because his testes constantly produce fresh young new sperm throughout his lifetime.

How are the odds of getting pregnant in your bedroom affected by your age ?

For healthy couples in their 20s and early 30s, about 1 in 4 women will get pregnant during a single menstrual cycle. This is called fecundity.  By age 40, about one in ten women will get pregnant each time they have their period.

Women who have babies later in life are more likely to have problems during their pregnancy .

For example, people over 40 are more likely to have high blood pressure. Preeclampsia is more likely to happen if a woman has high blood pressure before she gets pregnant. But studies also show that even if an older woman is in good health, she still has a higher risk of having complications during her pregnancy, which is considered to be high-risk because of her advanced age.

The risk of birth defects increases as a woman gets older.

 In general, the chance of having a baby with an abnormal number of chromosomes is low. But as a woman gets older, she is more likely to have a child with missing, broken, or extra chromosomes. Down syndrome (also called trisomy 21) is the most common problem with chromosomes that happens when women have babies later in life. The chances of having a child with Down syndrome is 1 in 1,480 at age 20, 1 in 940 at age 30, 1 in 353, at age 35, 1 in 85 at age 40, and 1 in 35 at age 45.

What can you do if you are worried about babies being born with problems?

Prenatal screening tests are done after you get pregnant and can figure out how likely it is that your baby will have a certain birth defect or genetic disorder.  Screening tests can also be done before you get pregnant, to check if you are a carrier of genetic diseases

Creating a reproductive life pan

All women should think about whether or not they want children and, if so, when they would like to have them. If you want to have kids someday, your plan can be as simple as saying, "I want to finish school and save more money before having kids," or "I want to have kids when I'm in my 20s, when my chances of having a healthy pregnancy are best." If you want to get pregnant soon, you should try to be as healthy as possible before you get pregnant. Take steps to stop drinking, smoking, and using drugs. You should also start taking folic acid, which is found in prenatal vitamins, to help prevent neural tube defects (NTDs).

What is prepregnancy planning ?

This is a visit to your ob-gyn that helps you plan for a pregnancy. During this appointment, your gynaecologist should review your medical history, the medical history of your family, any previous pregnancies, and any medicines you take. You should also check your immunizations to make sure you have all of the recommended shots, such as rubella.

How can you protect your fertility ?

At the moment, there is no medical method that can guarantee that a person will stay fertile. If you are married and know you want to have kids later in life, but don’t want to have a baby right now, you can do IVF and  freeze your embryos when you are young. This allows you to have your cake and eat it too, because you can transfer these healthy embryos into your uterus when you are ready to become a mom.

Another option is to freeze your eggs if you aren’t married. Social egg freezing has become very popular, and you should think of it as being an insurance policy if you want to postpone child-bearing for a few years.

How to get a 100% pregnancy rate in IVF

A 100% IVF success rate is the Holy Grail for all IVF doctors and patients , because it would make everyone's life so much easier !

The reason this is never going to happen is that human reproduction is not efficient. We know that about 50% of top-quality blastocysts will have genetic defects, which is why they will not implant , and we can’t either prevent this or diagnose it, because current preimplantation genetic testing ( PGT) is very flawed and inaccurate.

This is fact of life that both doctors, as well as well-informed patients, need to  come to terms with . They understand that they need to be patient until they get pregnant , and it’s impossible to predict in advance which blastocyst will become a baby.

However , many doctors are quite unethical and fool their patients by giving them an HCG injection routinely after the embryo transfer . Now this HCG hormone will appear in the blood and get excreted in their urine , which means both the Urine Pregnancy Test and the blood HCG test will be positive . The clueless patient will be ecstatic that the treatment was successful and that they are finally pregnant . They will give the credit to their doctor , and it is only when the HCG levels start dropping that they realise that they have been taken for a ride. It’s a handful of bad clinics that do this and end up giving all IVF specialists a bad reputation

How many IVF embryos should I pool ?

We are now routinely pooling embryos for many patients who want to postpone having a baby. These are usually young women , who don't want to have a baby right now because they want to pursue a career, but understand that babies born from the eggs of older moms have a higher risk of being abnormal; and older women , who understand that time is at a premium for them , which is why they need to generate as many embryos as possible , before they can think about transferring them .

As a woman gets older, it’s her ovarian reserve which drops , while her uterine receptivity remains the same , no matter what her age .

The tricky question is - how many embryos should they store , before they start transferring them. Now, if the implantation rate was 100% and they wanted 2 babies born a few years apart to complete their family, then we would need to freeze just 2 blastocysts, and transfer them one at a time.

Sadly, we know that about 50% of top-quality blastocysts will have genetic defects , and will not implant . Sadly, we do not have the technology to either prevent this or diagnose it, because PGT ( preimplantation genetic testing ) is unreliable and flawed, and generates incorrect information .

This is why we tell patients that if they want to have one baby, they should plan to store at least 4 top-quality blastocysts, because the cumulative conception rate is more than 80% if you transfer these 4, one at a time , over 4 cycles . This way, not only have you stacked the odds in your favour , you also have peace of mind that you have done your best !

 

How we perform Embryo Transfer under Ultrasound Guidance?

Saiprasad Gundeti, Chief Embryologist, Malpani Infertility Clinic

Embryo transfer is the final and the most crucial Step in IVF .

For our patients, we routinely perform embryo transfers on day 5 at the Blastocyst stage.

Safe Placement of Embryos in the ideal Location in the uterus is crucial.

We perform all our Embryo Transfer procedures under ultrasound guidance.

Ultrasound guided embryo transfer is the most efficient technique. It aids to track the catheter during embryo transfer and helps placing the Embryo in the desired location in the Uterine Cavity.

Better results are seen, when the Embryos are place roughly 1 cm away from the Fundus i.e. between mid of cavity and Fundus.

Steps Involved in Embryo Transfer -

1) Blastocysts (Day 5 Embryos) are selected and segregated for Embryo transfer. The blastocyst (s) is shifted to Embryo Transfer Dish containing Culture Medium or Embryo Glue.

2) The Embryologist loads the Blastocyst (s) into the Embryo Transfer Catheter under         

     stereozoom microscope. 

    - When we load  the embryo/blastocysts into the catheter, they are sandwiched between 2    

       air  bubbles.

     - we aspirate bit of culture media, followed by an air bubble, then Embryos with  minimal   

        amount of  culture media followed by another air bubble and finally bit of culture medium.

3) The catheter loaded with embryos are handed over to the surgeon, who passes it through

      the cervical opening into the uterine cavity.

4) Abdominal Ultrasound is used to track the catheter tip entering into the cavity.

5) when the catheter tip reaches the ideal location which is between fundus and mid of uterine cavity.

6) After few seconds of wait for stability,  the surgeon slowly pushes the embryo into the cavity.

7) few second of wait and then the catheter is slowly withdrawn by the surgeon and handed over to the embryologist.

8) The Embryologist checks the catheter under microscope by flushing it with some culture media to confirm  that the Embryos are safely placed in the uterine cavity and that the catheter is clean.

During Embryo transfer, in the abdominal Ulrasound it's not the catheter or the embryo which is visible in the USG, But the 2 air bubbles present in the catheter on both sides of the Embryo which are visible, make it easier for us to track the catheter and place the embryos at the desired place, which is roughly 1 cm away from the fundus.

The Embryo transfer catheter is made of soft polyurethane material that is non-toxic to the Embryos and most of the Catheters are not Echogenic (Ultrasound waves cannot be reflected back) which means it cannot be identified under ultrasound.

Similarly Culture Media is also not Echodense, to be able to get identified under ultrasound.

The  Air Bubbles are Echodense and easily identified under ultrasound.

Hence when we track the catheter in the uterus during the Embryo Transfer, it’s the Air bubbles which are seen in the ultrasound while the catheter going inside and post the Embryo placement in the cavity.

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!

Which are the best days to have sex to get pregnant ?

 

Which are the best days to have sex to get pregnant ?

A  woman can only get pregnant during a few days of her cycle because eggs and sperm only live for a short amount of time.

Sperm live for about 4 days, and eggs can only be fertilised for about 24 hours (one day) after they are released from the ovary.

For fertilisation to happen, eggs and sperm must meet at the right time. This is how an embryo is made.

So how do you calculate your fertile days ?

Your menstrual cycle begins on day 1 of your period ( when the flow of your bleeding starts) and ends on day 1 of your next period. If a cycle lasts between 21 and 35 days, that's considered normal. They can be different for each woman and each cycle.

If your menstrual cycles are different lengths, as they are for most women, you can figure out how long they are on average.

The length of a woman's period can change from one month to the next. Periods don't always come every month. Taking the length of three menstrual cycles and averaging them can help you figure out when you're most likely to be ovulating.

If you add up the number of days in three cycles and divide by three, you get the average length of a cycle.

When you know how long your cycle lasts on average, you can figure out when you ovulate.

About 14 days before your next  period is due to start, you will ovulate.

• If your average period lasts 28 days, you ovulate around day 14. Days 12, 13, and 14 are your most fertile days.

• If your average period lasts 35 days, ovulation happens around day 21, and your most fertile days are days 19, 20, and 21.

If your cycle is shorter, say 21 days, you ovulate around day 7, and days 5, 6, and 7 are your most fertile days.

The three days before and including the day you ovulate are when you are most likely to get pregnant.

After you ovulate, you become infertile, because the cervical mucus dries up and does not allow the sperm to enter the uterus.

Some women have very unpredictable cycles or find it hard to figure out the average length of their cycles. This can make it hard to know when you're going to ovulate. If it's too hard, having sex every two to three days takes care of everything and makes it more likely that you'll get pregnant.

 Is your most fertile day Day 14?

You may have heard that you ovulate on day 14 of your cycle. So, many people have sex on day 11, 12, or 13 because they think that will give them the best chance of getting pregnant. But ovulation doesn't always happen on day 14. Normal ovulation can happen anywhere between day 10 and day 20. If your periods are not regular, ovulation can happen even later. So, you can't always say that day 14 is your most fertile.

Is IVF the most effective treatment for infertile couples ?

 IVF, or in vitro fertilization or test tube baby, is the most effective treatment option for infertile couples. The great thing about IVF is that treatment protocols have become standardized. And equally importantly, it allows us to solve any problem no matter what it is because we can bypass problems by doing IVF, which means what's not happening in the bedroom whether because the tubes are blocked or the sperms aren't good enough we can actually do it in the IVF laboratory.

But we also need to remember that IVF is not just a treatment option; it also provides us with very valuable diagnostic information and prognostic information. And let me explain a little bit about what I mean as far as diagnostic information goes, it tells us exactly how well the woman is capable of responding to a superovulation protocol.

We know that as women get older, their ovarian reserve drops, which is why we measure their AMH level, and their antral follicle count, but these are static measures, and the proof of the pudding is in the eating. So you can only know what the responses are by doing an IVF cycle, which means you'll have patients with an AMH level who still respond very well to a superovulation protocol.

And this is the information we can only get by actually doing an IVF treatment cycle. And more importantly, because IVF treatment cycles are dynamic, if the ovarian response to one particular standard superovulation protocol is not very good, we can change it for the next cycle. Equally importantly just like it allows us to dynamically assess ovarian response in the sense not only how many eggs do we get how mature the eggs are, but how many are fertilized did they form good quality embryos or not which is invaluable information.

Because it helps us tell the patient what to do differently next time. And that's why not only is it therapeutic as well as diagnostic, it's also prognostic because we can tell the patient, "Look, you know, we don't think your ovary response was good or that your embryo quality wasn't very good because the egg quality wasn't very good." So next time, if changing the protocol doesn't work, we might want to consider donor eggs.

This then becomes a well-informed decision based on valuable data, which only an IVF cycle can provide, but you're making well-informed decisions, and that's true for sperms as well, so for example, the only way of finding out if sperm are capable of fertilizing an egg is by actually doing IVF. Most patients don't know this, and most doctors won't tell you this, but the correlation between a semen analysis report sperm count, sperm motility with actual sperm fertilizing ability is very poor, which means you'll have men with low sperm counts whose sperms fertilize their wives' eggs in the lab, and conversely, there are people whose count looks perfect and whose motility looks good whose sperms don't this is why an IVF cycle can actually allow us to assess sperm fertilizing ability.

Lots of clinics don't want to take the risk of total fertilization failure, which is why they won't do IVF, and they'll straight away do exceed, which means we will definitely get fertilization but we won't be able to assess whether the sperms were capable of fertilizing the eggs or not, and that's sometimes a trade-off, and it's something you need to discuss with your doctor so you can make a well-informed decision. So please don't underestimate the power of an IVF cycle.

It maximizes your chance of having a baby. It also clearly tells you why perhaps you weren't getting into your bedroom pregnant for so many years, And equally importantly, it gives you much more valuable information as to what you can do for the future to maximize your chance of getting 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!

How to get pregnant fast !

Can you do anything to get pregnant quickly? Definitely! The best way to get pregnant is to have sex at least once every other day while you are fertile. But know that not every couple will get pregnant quickly, even if they do everything right. But you can make your chances better.

Some people get pregnant after a month or two of trying. But, for most, it takes longer. Keep in mind that it could take months to get pregnant, and that one in ten couples will have trouble getting pregnant. There is help out there, which is good news.

It's important to remember that these tips might not work for everyone, especially if you have problems with your fertility that have been going on for a long time. Pregnancy isn't something that can be planned exactly, which is sad. Don't blame yourself if you can't get pregnant as quickly as you'd like. Instead, keep trying. Most couples will get pregnant within a year if they keep trying.

1. Stop using birth control!

If you want to get pregnant, it makes sense that you should stop using birth control. Your fertility may need time to come back, especially if you have had an IUCD inserted. Talk to your doctor about when you can start trying to get pregnant so you know what to expect.

2. Have a lot of sex

Having sex often for a whole month can help you get pregnant. Every other day or every two days is a good amount.

You could try to have sex every day , but most people will get tired of it, and it's not really necessary. If you have sex three to four times a week, you are more likely to have sex on your most fertile days, which increases your chances of getting pregnant. If you wait and only time sex at ovulation and you get the timing wrong, you may lose that month.

Having sex often also makes sperm healthier. If you are healthier, you are more likely to get pregnant.

Normal personal lubricants like KY Jelly are bad for sperm, which is something you should know. Your own cervical fluid is the best thing to help you get pregnant. But if this is a problem for you, there are options that are good for sperm, like liquid paraffin.

3. Find out when you ovulate.

The two days before you ovulate are when you are most likely to get pregnant. You can find out which days these are in a number of ways, such as by looking for fertile mucus in your cervix. 

You might have an easier time if you use ovulation kits or monitors.

4. When to seek help. 

See your doctor if you don't get pregnant in six months (if you're over 35) or a year (if you're younger than 35).

Getting help doesn't mean you're giving up; it just means you're brave enough to find out why you can't get pregnant and what you can do about it. Some of the things that cause infertility get worse over time. If you get help when you need it, it might help you get pregnant faster.

What you should know while you are undergoing IVF treatment ?

 The good news about IVF is that, because it's been around for so many years, treatment protocols have become very standardized. which means most IVF clinics will know exactly what to do for the patients who come to them, which is great because patients are no longer being used to skinny pigs Not that they were ever used to skinny pigs, but there was a lot of uncertainty involved, a lot of which has now disappeared. So we know pretty much how to treat any patient who comes to us. 

Having said this, there is a certain degree of trial and error involved in every IVF cycle because, even though we use a standardized treatment protocol, not every patient is standardized, and every patient is going to respond differently to any protocol we use. Now we will categorize patients, for example, based on their age or based on their AMH levels or their antral follicle counts, or what we think will reserve isn't even based on their response to previous IVF cycles.

 But having said all this, no matter how many tweaks you make or how many well-informed decisions you make, the proof of the pudding is in the eating, and it's only by actually doing the IVF cycle that you will learn what went well and equally what didn't go well. Conceptually, I tell patients to think of IVF as a series of hurdles; you need to cross all the hurdles to reach the finish line; you need to grow the follicles; we need to get the eggs out, we need to check the eggs are mature; the embryologist needs to fertilize the eggs; we need to make good quality blastocysts, and they need to implant. Some things are in the doctor's hands, some things are in the patient's hands, and of course, a lot of it is in nature's hands, and we really can't control the implantation process.

This is why we do a certain amount of tweaking, and this is why monitoring during an IVF cycle is so important. Is the patient responding the way we expect it to respond, or is there something that is going on that is not what we'd expected? We can cause correct based on these studies or levels based on follicular scans based on what we think the ovarian responses are, and this is valuable information, and that's why we tell patients, it's so important that you know in advance what your IVF doctor is going to do for you. This is why we have standard treatment templates and standard treatment protocols. So ask your doctor what the protocol is for the treatment.

They should give it to you in advance, even before starting the cycle, so that there are no unexpected surprises; you know exactly what's going to happen; you're in control of your life and if things are going the way you expected that's great. Equally, this will tell you if things aren't going the way we expected, we need to make some changes, so you can have an intelligent discussion with your doctor and ask them what changes they're going to make and why, and sometimes we can make these changes during the IVF cycle itself. So for example, when we start the superovulation, it usually takes about five days of gonal F or HMG injections or FSH.

 We can check ovarian response by doing an ultrasound scan and checking the E2 level, and if it's not okay, that's a moment of truth during that IVF cycle. We can sometimes bump up the doors or sometimes we need to make certain changes in the protocol, like adding different drugs, and if we can't make those changes in that IVF cycle, we're sometimes forced to cancel the cycle. But that's still valuable information because we can use this information to improve the treatment protocol for the next IVF cycle, and that's why you, as a patient, need to be well informed as to what the treatment plan is going to be. You need to know what's going to happen next and what the expected response is. If things aren't going according to plan, your doctor should be able to explain to you what he's going to do, and armed with this information, your anxiety and stress levels will be much less because you are in control of what's happening.

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 spirituality helps in IVF treatment ?

Spirituality and IVF treatment it might seem unusual that an IVF doctor is talking about spirituality, but the reality is that IVF treatment is highly taxing on the patient. No matter what you do, the outcome of an IVF cycle is always going to be uncertain because there are so many moving parts and so many variables, and we cannot control the final outcome because even though our technology is very good at making embryos, once you put that embryo, that blastocyst is back inside the uterus, whether it's going to implant or not is something you can't control, and not something a doctor can control either.

And this is why IVF doctors need to be humble and realize that there is a lot we can do, but equally, there's a lot we can't do, and that's why it's important that patients have realistic expectations as to where the problems arise. When doctors make huge promises, when they promise the patient the earth and the moon, don't worry, our success rates are 90%.

You're young, your chances are very good, there's a top-quality embryo, of course, you're going to get pregnant. And then, because the patient's hopes are so high, misleading the eye, of course, because the doctors are lying to them, when that cycle fails, the patient goes to pieces. The patient is crushed. The patient was sure she was going to get pregnant. The doctor told her she was going to get pregnant. Then when the cycle fails, she doesn't know what to do next and therefore she takes her anger out on the doctor. But you know what, the doctor magically starts telling a completely different story I did everything possible.

It's just your bad luck. You're in that 10%. All the other 10 patients in my clinic got pregnant. You must have done something wrong. Maybe you did not rest or you got too stressed out or you didn't take the medicines, classical victims, blaming bad doctors these are the same doctors who hide information from patients and do not give them photos of the embryos. So there's no transparency, no accountability, no instability, and the poor patient is tough and the patient is forced to believe what the doctor tells them even though it's a complete lie.

And that's why spirituality is so important because it gives the patient a certain degree of stability and a certain degree of being able to cope with uncertainty. An IVF cycle is full of ups and downs and you never know which cycle is going to work or why it didn't work, so when the cycle is going well, you're growing eggs, you have good quality embryos, you hope for them but they don't implant, you get depressed.

It can be very hard to live with these ups and downs and that's why with spirituality you understand that there's lots of stuff in your life that you can't control. If nothing else, spirituality helps you come to terms with the fact that there is no point in worrying about the hundred things in life which you can't control you only need to focus on the things which you can. The good news is that there's a lot in your control and the most important thing in your control is being well-informed about IVF treatment so you can find the right IVF doctor.

You want a doctor who's open and transparent kind, shares information with you, and tells you exactly what's going on, so you are in safe hands. You need to be able to find a doctor whom you can trust. You don't need to become an IVF expert, if you find the right IVF expert, that's the secret and the only way to do that is by investing in information therapy and also understanding that not everything is in human hands. The sooner you do this, the easier the ride will be for you.

How to choose the right IVF doctor ?

 Choosing the right IVF doctor, selecting the right IVF doctor is the most important decision an IVF patient can make because this is the only thing that is in your control. You can't influence your ovarian reserve. You can't influence your husband's problem If your tubes are blocked, you can't magically open them up, and once the doctor puts an embryo back in the uterus, you can't do anything about whether it's good to implant or not, which means there are so many things which are outside your control.

And obviously, this is scary, and I completely get it, because no matter how much money you spend, no matter how many prayers you give,  no matter how hard you work, and no matter how much energy you invest, you can never be sure which IVF cycle is going to work or even if it's going to work. But the one variable you can control is selecting the right IVF doctor, and it always breaks my heart, how little time and energy patients spend on selecting the right doctor.

 Most IVF patients, in general, especially in India, are extremely passive. They're willing to leave everything up to the doctor. They say, "Yeah, this must be a good doctor. My bhabi went to him and became pregnant, or my GP referred me to him. He must be a good doctor. " But obviously, they don't talk about the kickback the IVF doctor must have given that GP for that referral, which means they really had no clarity at all. And then you have all these clinics that do free IVF counseling camps, which will again bring your patients to come into them. And when patients are badly informed, they're very easy to take for a ride.

Sadly, most IVF patients are ignorant, gullible, and emotionally vulnerable. There are lots of unscrupulous IVF clinics that will actually use a lot of scanning techniques to make patients do treatment that is not in their best interests. Sadly, because patients haven't invested the time and energy in information therapy to make sure that they understand what's involved in an IVF treatment, they understand what a good doctor does. It's very easy for a bad doctor to take that for a ride, which means these doctors don't share information proactively. They do not provide photographs of embryos to these patients. They don't tell them how many follicles are growing, and they come up with all kinds of ridiculous explanations and answers when the IVF cycle fails.

Now an IVF cycle failing is a heartbreak I completely get that, but when the IVF cycle fails because of the incompetence of an IVF doctor, this is adding insult to a journey, and then look what happens to the poor patient. That patient has burnt her fingers. She's never going to trust any IVF doctor. In her head, all IVF doctors are thieves. They all lie. All of them are equally bad. and I think the only way to prevent that problem from happening is by doing all your homework before you sign up for the IVF cycle. Unfortunately, most patients are very naive and immature.

They assume that all doctors are going to be equally good and the reality is that they aren't, and it's only after their first IVF cycle fails, they start doing their homework, going online and understanding what's involved, understanding what a doctor can do and what he can control, and then when they realize that that earlier doctor cheated them and ripped them off, they're extremely bitter, but sadly, the harm is already done and that's why the best way to immunise yourself against bad doctors, to make sure that you don't get trapped by a bad And the good news is, thanks to the internet, it's become extremely easy for you to do so. So please do this before you sign up, and if you do this, your chances of finding the right IVF doctor are much better.

How to make right decisions during IVF treatment? | IVF tips

 Making decisions during your IVF treatment: It's always very difficult to accept the fact that you're going to need IVF in order to get pregnant because obviously, everyone would rather make a baby in the bedroom. Who wants to go to a doctor and get poked and prodded in order to get pregnant, something which millions of women do in their bedrooms all the time? This means, as it is, by the time patients come for IVF, they're a little bit depressed, unhappy, have low self-esteem, and there's a lot of confusion in their minds because they've heard so many things about IVF but they're not sure what's right and what's wrong.

There are so many myths; there are so many misconceptions, there are so many misleading websites, and it seems that everyone who has had a baby has become an infinitely expert simply by virtue of the fact that they made a baby in their bedroom themselves. And this is why sometimes making decisions can be so hard Making decisions is always hard, and it's harder for IVF patients because you know that the success rate is not going to be 100%. There are so many variables, and the problem is, you can't control what the final outcome is going to be. The good news is that you should be happy that at least the technology options are available to you. If you had come to us 60 years ago, I would have said, "Look, I'm sorry your tubes are blocked, I can't do anything, or I'm sorry your sperm count is zero, we can't do anything for you." Today, with IVF technology, there's practically no medical problem for any infertile couple we can't solve, so that's the good news.

Yes, I understand it's expensive, I understand the outcome is uncertain, and I understand it may take time before you get pregnant, but at least there's light at the end of the tunnel. This is why when we do an IVF cycle,, it's very important that you make the decision for yourself, so you're in control of your life.

Whenever we make decisions now, we partly use our heads, we use our logic, we try to be rational, and we partly use our hearts. We listen to our emotions, we listen to our feelings, and the fact of the matter is that you can't just use your head and you can't just use your heart. You need to use both and, in fact, it's usually the heart that leads the head.


Unfortunately, this is something that doctors often forget. Doctors think of themselves as being scientific professionals who will only think about technology and technical bits and bobs, and this is the treatment you require, and they forget that their patients are hurting on the inside. The fact that they can't have a baby is disrupting their lives; it's disrupting their careers, it's disrupting their marriage, it's making their relationships with friends, family, and relatives extremely hard, and that's why doctors need to be empathetic, and this is why, as a patient, you need to understand that it's okay to be swayed by whatever. After all, you're a human being. You're not a machine. You're not an animal. You don't have feelings and need to respond to this, but you also need to find the right blend.

The right thing to do is to listen to both your head and your heart. At the end of the day, if for whatever reason, your gut tells you this is not the right solution for you, please respect your gut. It's important that you own the decision and just using your head isn't enough because you need to live with the consequence of that decision for the rest of your life and if you've used both your heart and your head to make a decision you're comfortable with, you'll be happy, you'll be able to keep your baby happy, you'll be able to keep the rest of the family happy. Whereas, if you make a decision you are not happy with, everyone's going to be miserable because you're going to be miserable.

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!