Saturday, May 21, 2022

My IVF cycle failed. What do I do next?



Failing an IVF cycle can be heartbreaking. It's often your worst nightmare coming true. You've gathered all that money, taken that big risk, taken all those shots, and done everything possible in order to get pregnant, and blindly followed all the advice given. No, you have not complained even once. And the doctor was so hopeful and optimistic and yet the cycle failed and you feel you've let everyone down - that your body doesn't work properly. That the embryo didn't implant, that you must be cursed, that your fate is bad. And that if that cycle fail, you're never going to get pregnant. After if IVF fails, then what else is left for the future? 

You you need to remember that the pregnancy rate is never going to be a hundred percent ,  and that in fact, the odds of failing in a single IVF cycle are actually much more than the odds of succeeding in a single IVF cycle. But over time -  over multiple cycles, the odds are then stacked in your favor. The important thing is to analyze the failed cycle, so you can learn from it. so you can learn what to do differently the next time. 

Now this might seem quite daunting for a patient. What do I understand about IVF? I'm not a doctor. I do everything my doctor tells me to do. My doctor was very hopeful and he was sure I was going to  get pregnant. And yet it failed. Is there any hope for me at all? 

Part of the problem is sometimes patients aren't even sure that they can trust the doctor , because after the cycle fails, the doctor comes up with all kinds of spurious reasons and explanations for, "Oh, maybe the embryo wasn't good". "Maybe your uterus wasn't good. "Maybe your uterus rejected the embryo". "Maybe you have some immune antibodies". "Maybe we need to do some additional tests" - all kinds of excuses . And you wonder why didn't the doctor tell you all this before doing the embryo transfer rather than after the cycle fail. So your confidence levels, not only in yourself, but in the doctor also, are going to go down. 

You need to understand that IVF isn't really as complicated as most doctors make it out to be after all, what are the four things which you can change in an IVF cycle. That's all you need to figure out. 

There are eggs. There are sperms. There is the uterus.  And finally there is the doctor. So these are the only four levers, which you can change. Now, if you have a top quality blastocyst ( and the doctor has given you a photograph of this), the transfer was smooth, and your endometrium was good, then the reality is there's no need to change anything. It's just a question of repeating the cycle until it works. And of course, if you have a frozen embryo then repeating it is much easier because the cost is much less and you don't need to take injections. You need to come to the clinic just 2 or 3 times and the doctor puts your embryos  back and you have an extremely good chance of getting pregnant -  maybe in the second or the third cycle,  provided you don't give up and get disheartened. 

But suppose the cycle didn't go well, then what do you need to analyze ?  Did you get poor quality embryos? Because your eggs weren't very good ? Was this because your your ovarian response wasn't good because you have poor ovarian reserve ? Or did the eggs not fertilize well ? Or did the embryos started fragmenting from day two or day three.

Or was it a problem with the sperm? Did you have total failure of fertilization? If you did ICSI (Intra Cytoplasmic Sperm Injection). maybe not enough of the eggs fertilized properly perhaps because the embryologist just didn't do a very good job. 

Analysing uterine receptivity is not very hard, because if you can see a tri-laminar thick endometrium on an ultrasound scan, this usually means the uterus is receptive. 

Of course, when a cycle fails, doctors want to change something, and patients want them to change something too . And the easiest thing to change is the uterus because the commonest reason a doctor gives is - Your uterus rejected the embryo, which is why it didn't implant.

Even though this is a lie, this is something which patients are very likely to believe. This is partly  because they have low self-esteem as a result of their infertility, and they know their body doesn't work properly. And then when, in spite of the fact that the doctor made an embryo, put it back, and yet they didn't get pregnant , this means obviously their uterus is flawed ! It rejected the embryo and they need to change the uterus and do surrogacy. But the reality is that most IVF cycles which fail aren't because of problems with the uterus because the uterus is usually passive. The problem is often with the eggs, rather than the uterus.  

And finally, the fourth variable is the doctor. If you feel the quality of care, wasn't good; the doctor didn't spend enough time with you; the doctor didn't bother to answer your questions.; was was not open, and didn't give you photos of your embryos ; or you never got a chance to see the doctor because he was busy in some other clinic and you had to talk to assistants every time. This means it's time for you to consider changing your doctor. And if you're not sure what to do, please reach out to us.

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !


Thursday, May 19, 2022

What to do if you are stuck with a bad IVF doctor

 



Most patients are very naïve when selecting an IVF clinic, because they believe that all IVF clinics are equally good. They will sign up for IVF treatment at the nearest clinic , or at a clinic to which they have been referred by their family doctor , or perhaps to a clinic they have read about in an ad .

However, after they start their treatment , they realise that they are receiving very poor quality care . After they have paid their fees, they don’t get to see the brand-name doctor, and their treatment is handled by clueless juniors and disinterested assistants.

They have no idea as to how their cycle is progressing , and the clinic refuses to share basic medical information ( such as the number of follicles on the ultrasound scan, and their sizes). They refuse to provide photographs of the transferred embryos , so when the cycle fails, the poor patient has no idea what the real reason for the failure is .

The doctor then starts Operation Coverup ! He hides all the information, and then pushes the patient into doing even more tests, or suggesting more expensive treatment , by blaming the patient’s eggs, sperm, or uterus for the failure , when in fact the real reason for the failure was the fact that the doctor was incompetent , which is why the embryos were of poor quality.

Patients are smart , and they suspect the doctor is hiding information from them , and not being honest, but they don't know what to do when they are stuck with a bad doctor. This is partly because they have already spent so much money , that they are very reluctant to walk away – especially when the clinic has signed them up for a 3-cycle package by offering them a discount for this !

They are scared to take the time and trouble to find a new doctor , because they can't really be certain that the new doctor will be any better than the old one , and they are scared they will end up jumping from the frying pan into the fire. Another fear is that the new doctor will make them repeat all the tests all over again , meaning they will end up wasting even more time and money.

The one thing you should remember is that if you are stuck with a bad doctor , then continuing with him will only lead to more grief , and will just make a bad situation worse. There's no point in regretting what you have done in the past , because this is a sunk cost and you can't undo it, but you can definitely learn from your mistakes , so you can choose a better doctor the next time around !

Your first step is to get a copy of all your medical records , including photos of your embryos. If the clinic refuses to share this , please remember that your medical records are your property , and doctors cannot refuse to give them to you ! If they do, send them a legal notice please !

After you have obtained your records, the next step is to get a second opinion , so that you can determine the lacunae in your treatment ,  and can move on to a better clinic . The good news is that your ability to find a better clinic will now increase dramatically because of all the mistakes which you made in your first IVF cycle ! 

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 !





Wednesday, May 18, 2022

What to do when the doctor isn't able to collect any eggs

 


One of the reasons IVF cycles fail is because doctors tell patients that they weren’t able to collect any eggs during the egg retrieval . This can come as a rude shock, because patients expect doctors to be able to collect one egg from each follicle , and it’s very hard to understand why they weren’t able to retrieve any eggs at all .

When doctors don’t get any eggs, they commonly lie to the patient, and tell them they suffer from the rare condition called empty follicle syndrome ! This is not true, because empty follicle syndrome is a very specific condition which can be diagnosed only by doing special tests, but doctors don’t bother to do this , and will use this diagnostic label as a pretext to cover up their own incompetence, which is what really caused them to fail to collect any eggs.

Let’s look at the real reasons why some doctors aren’t able to find any eggs at the time of egg retrieval. One of the commonest reasons is that the follicles have already ruptured before the start of the egg collection . This is not uncommon, especially in large clinics that do many egg collections in a day , because they "batch" their patients together into one group. If the doctor waits for longer than 38 hours after the HCG trigger , the follicles will rupture, and the eggs will be lost in the peritoneal fluid. However, the doctor will refuse to take any responsibility for this negligence, and will hide the truth so that patients remain completely in the dark.

Another reason why the doctor may not be able to collect any eggs is that the doctor may not be technically competent . This is becoming increasingly common in IVF corporate clinics that run large chains , because they are happy to hire any doctor they can find , no matter how inexperienced or clumsy he may be. This is because their focus is not on providing a high quality clinic service , but on doing as many IVF cycles as possible , to maximise their profits. Many of these junior doctors don't have the experience or the expertise to collect eggs for challenging patients—especially when there are only a few follicles ( in patients with poor ovarian reserve), or when the ovary is hard to reach because of adhesions. The doctor blames the poor ovarian function, and then uses this as an excuse to tell the patient to use donor eggs for the next cycle.

Another problem could be a bad embryologist , so if he is not experienced enough , he may fail to identify the oocyte cumulus complexes in the follicular fluid that the doctor sends at the time of egg retrieval. He will claim that no eggs were found, and the hapless patient will never get to know the truth , because it's concealed , and no one is willing to take responsibility for the mess.

Finally , another reason could be equipment malfunction , so if the lab is not well equipped , or if there is a loss of electrical power, the suction pump used for the egg collection will not create the negative pressure needed, or the stereozoom microscope used in the IVF lab will stop working.

The result of this sad saga is that the poor patient will waste all their time , money, and energy - and to add insult to injury, the doctor will lie and tell the patient that there was a problem with her eggs, and she will need to use donor eggs in her next treatment cycle, which is a complete lie.

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Monday, May 09, 2022

Embryo transfer versus embryo implantation

 


One of the problems that plagues IVF today is that most IVF patients are still very poorly informed about the medical details of an IVF treatment cycle . Patients justify their ignorance by saying that they don’t need to worry about the technical minutiae , because that is the job of the doctor ; they don’t understand the medical jargon, and that a little knowledge can be dangerous !

If you do go to a good doctor who takes the time and trouble to explain the details to you, and is transparent and accountable , you will be fine . But what happens if you don't go to a good doctor ? Or if your doctor is not willing to be open and transparent about your treatment, and who hides critical medical  information from you, because they know they are incompetent ? This is the kind of doctor who will take you for a ride , because you don't know enough to be able to protect yourself – and sadly, this is still the majority in India today.

This is why it’s so important that you invest in Information Therapy ! A good doctor appreciates patients who have taken the time and trouble to educate and inform themselves,  because they have realistic expectations of IVF treatment, and this makes life much easier for both the patient and the doctor , because they are on the same page .

The patient knows exactly what to expect, and can check if the doctor is doing this, because they understand what to expect. This also reduces their stress levels because they are less anxious, since they know what’s going to happen next.

On the other hand, bad doctors get very upset when a patient is well informed because they know they are not going to be able to cheat this patient . They often get angry with the patient who asks them questions, and will insult them by telling them that there is no point in their becoming a half-doctor !

You need to protect yourself , because you can't automatically assume that every doctor you go to is a good doctor . This is why you need to understand the difference between embryo transfer and embryo implantation . Embryo transfer is a simple clinical procedure that we do routinely. This is done under ultrasound guidance, and good clinics will always provide photographs of embryos , so that patients know that the treatment has been done well . Until the point of embryo transfer , the medical treatment is in our hands , but after we transfer the embryo into the uterus , whether that embryo will implant and become a baby is not something which anyone can control , because this is a biological process , and human reproduction is not very efficient . This is true , whether you are trying to make babies in your bedroom or whether you are doing IVF  - and this is why every fertile couple doesn’t get pregnant every month they have sex !

We have no control over the implantation process – it’s still a black box for us. This is why patients need to understand the difference between embryo transfer and embryo implantation, and this knowledge is extremely important , because you can then decide what to do next in case the first IVF cycle fails !

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 !





Sunday, April 24, 2022

The difference between menstrual periods , ovulation and fertility



You have learned in your high school biology classes ( hopefully you were paying attention !) that a fertile woman ovulates regularly, which is why she has regular menstrual cycles, and that the central key event in the menstrual cycle is ovulation the release of a mature egg from a ripe ovarian follicle, which normally occurs once a month.

If your cycles are irregular , this suggests that you are not ovulating.

This is called anovulation, and you can read more about this at  www.drmalpani.com/knowledge-center/articles/anovulation

 A common reason for this is PCOD ( polycystic ovarian disease) and you can read more at http://www.drmalpani.com/knowledge-center/the-infertile-woman/how-to-manage-your-pcod

Another possible cause could be poor ovarian reserve  and you can read more about this at http://www.drmalpani.com/knowledge-center/the-infertile-woman/oopause

However, you should also remember that just because your cycles are regular does not mean that you are ovulating . For example, some women have LUF, or luteinized unruptured follicle syndrome, where the follicle matures, but the egg remains trapped inside the follicle because it does not rupture.

Also, just because your cycles are regular does not mean that you can assume that your fertility is normal either. As you get older, your ovarian reserve declines, which means the quality of your eggs may be good enough for you to get regular periods, but this does not mean the quality of eggs is good enough for you to be able to have a baby.

The biggest problem, of course, is that you cannot see your ovulation , and all you can see is your menstrual period . This is why women often worry about the quality of their menstrual flow - whether it's black or red ; painful; scanty or heavy; and has clots. However, there is very little correlation between the quality of your menstrual discharge , ovulation, and fertility , so please don't get misled by this.

One of the biggest problems is that there is very little education about human reproduction , as a result of which most women remain completely clueless about the relationship between fertility , ovulation and the menstrual cycle . This is why you need to invest in Information Therapy , so you understand the differences,  and don't end up jumping to the wrong conclusions.

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 !





Saturday, April 16, 2022

How to identify a bad IVF clinic



Many patients can’t travel to Mumbai to take treatment in our clinic, which is why a common question they ask me is – how do we identify a good IVF clinic? After all, the better the IVF clinic you choose , the better your chances are of getting pregnant !

The trouble is all IVF doctors are very friendly when you visit them for the first time. They are happy to promise you a baby , and they all claim to have the highest success rates when you go for a consultation. You only learn how incompetent they are after your cycle has failed, because they refuse to provide you with any information.

Here’s a solution to protect yourself from being taken for a ride. Use the following simple tool to identify a bad clinicand by rejecting all the bad clinics, you will finally identify a good clinic !

Part of the problem is that patients can be quite naïve and immature , and they believe that all IVF clinics are equally good . The other problem is that patients don't feel they are qualified enough to be able to differentiate between a good IVF clinic and a bad IVF clinic . After all, they are just patients , whereas the doctor is the medical expert . How can they challenge his authority ?

The good news is that you only need the clinic to answer 2 simple questions to identify a bad clinic. You can get these answers by phone or by email, so you don’t even need to waste time and money on doing a consultation ! Please make sure you get the answers before you sign up, because after you have paid your money , you may get all kinds of answers that may not be honest.

The first question is does the clinic routinely give photos of embryos to all their patients ?

This is important because the thing an IVF clinic can do is make embryos. After we transfer them, whether they will implant and become a baby is not something which is in our control because implantation is a biological process that is notoriously inefficient and unpredictable.

Every good clinic takes pride in producing good quality embryos, and they are happy to provide photos to their patients so they can see for themselves that the clinic has provided high quality medical care. This means that if the clinic refuses to provide embryo photos , you need to worry about why they are hiding such important and valuable information from their patients ! The most probable reason is that the quality of care they provide is poor , which is why the embryos they create are of poor quality , and they don't want to share this bitter truth with their patients , because they are worried that they will leave them and find a better clinic.

The second simple question you need an answer to is: Do you do blastocyst transfers only for all your patients ? Now, I understand this is a technical term, and IVF patients are often not sure what the difference between an embryo and a blastocyst is. This ignorance can be expensive, because you do need to become an expert on your problem before starting an expensive IVF treatment cycle on which so much of your happiness depends . An embryo that is grown to Day 5 in the lab is called a blastocyst, and this has a much better chance of implanting , which is why all good clinics all over the world will only do blastocyst transfers for all their patients . This is because a Day 3 embryo does not belong in the uterus; it belongs in the fallopian tube, so it makes no sense to put it back in the uterus so prematurely. The stage at which an embryo reaches the uterus is only on day 5 , by which time it has formed a blastocyst and is ready to implant.

If you find a clinic that answers "yes" to both these questions, then you can be sure the clinic is technically competent, and you can be comfortable taking treatment there.

On the other hand, if the clinic does not answer yes to either of these two questions ( and you can ask the nurse or the receptionist for the answers! ), you should stay far away , because this is clearly a bad clinic that is going to hide information from you , and this is not in your best interests ! 

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 !





Saturday, April 09, 2022

What are my chances of IVF success ?

 


One of the commonest questions every IVF patient asks at the time of a consultation is - Doctor, what are my chances of success ? This seems to be a very simple question , and one would expect that IVF doctors should be able to answer this easily – after all, we are medical specialists , with years of experience and expertise !

However, the reality is we can't answer this question, and the truthful answer is – No one knows . Unfortunately , this is not the answer which patients want to hear , and because doctors are smart , rather than be honest and tell them that no one in the world can answer this question accurately, most IVF specialists are happy to put a positive spin on the number and promise them the earth and the moon in the hope that they will sign up for IVF treatment in their clinic. This is why so many Indian IVF clinic websites claim exaggerated success rates of 80% and more !

The reason for our ignorance is because we cannot predict the chances of success for an individual patient in an individual cycle – after all, doctors aren’t fortune tellers, and the law of small numbers makes prediction impossible,

This is because embryo implantation is one of those biological variables over which we don't have any control - and if we can't control something , how can we predict what's going to happen ?

The trouble is most patients aren’t mature enough to accept this reality , and badger the doctor to provide some kind of a number . Doctors are very happy to pull a number out of a hat – and they know that the higher the number they quote , the happier the patient will be – at least for now !

The trust is this percentage ( and some doctors are happy to say it’s 90% !) is a meaningless number ! While clinics can provide a base rate – the probability of success in a group of women with a medical history similar to yours - the reality is that you don't care what happens to the 99 other women in the clinic - you only care about what happens to you !

This is why an “ 80% success rate “ is meaningless for an individual patient , because your outcome is going to be binary - it's either going to be 100% , or 0%. Sadly, most patients are innumerate, and don’t understand that statistics can be applied to populations , and not to individuals .

Unfortunately , doctors don't bother to explain this , and are quite happy to provide the patient with false hope and sweet talk them into signing up by quoting any number they want.

The harm this causes is that patients then have very unrealistic expectations of success , and then when their IVF fails, they go to pieces , and cannot gather the courage to try another cycle , so the false short-term hope causes long-term pain !

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 !



Wednesday, April 06, 2022

How to bounce back when your IVF cycle fails



It can be very hard to accept the fact that your IVF cycle has failed, because every patient does every IVF treatment with the hope that it's going to work !

Many women will repeat the HCG test multiple times, because they aren’t willing to confront this bitter truth, while others will go into mourning.

It’s important to be prepared to deal with failure , because it’s impossible to predict which cycle will succeed. Having realistic expectations and arming yourself with Information Therapy can help you deal with these ups and downs, and make you more resilient.

When your beta HCH comes back as negative, the first step is to learn to be kind to yourself . Please stop blaming yourself for the failure – this is not something that is in your hands. You need to allow yourself enough time, space, and privacy to grieve, so you can bounce back without indulging in an orgy of self-pity.

The outcome of an IVF cycle is uncertain and unpredictable, no matter how good the doctor, or how well the cycle progressed. You are not responsible for the failure , so please don’t allow other people to start blaming you . It’s very common for well-meaning "aunties" to explain the failure by saying that the embryo did not implant because you didn't rest enough, or because you ate something "hot", or because you lifted weights, or because you took on too much stress. They are completely clueless, so it’s best to ignore them. If they become too intrusive, ask them to show you their medical degree !

Please don’t blame your doctor either ! It’s hard to be kind to him, because he is a soft target, but good doctors want all their patients to get pregnant, and when the cycle fails, it can be distressing for the doctor as well !

After you have finished grieving, you need to learn to bounce back and think about the future. The first step you need to take is to review all your medical records especially your embryo photographs. If you don’t have photographs of your embryos, this is a major problem , because it clearly suggests that you have not received good quality medical care. All good IVF clinics routinely and proactively provide embryo photos to all their patients to document that they have received the best medical care.

You then need to get a second opinion based on your medical records,  so you can decide whether your current clinic is treating you well, and is  on the right track , or whether it's time to change your doctor.

Now you don’t need to reflexively change your doctor just because your cycle failed – but if the quality of your embryos was poor or if the doctor refuses to give you photos of your embryos, you should definitely consider getting treatment from a better clinic that provides embryo photos routinely to all its patients and does only blastocyst transfers.

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 !





Tuesday, April 05, 2022

How to win the IVF jackpot !



Most patients think of IVF as being a highly scientific , precise, and accurate process , and whenever they start an IVF cycle , they do it with the expectation that they are definitely going to get pregnant . After all, the doctor is making an embryo in the IVF lab and putting it back in the uterus , and there is absolutely no reason why the cycle should fail if the embryo is good, the uterus is healthy, and the doctor is competent. After all, isn’t an embryo the starting stage of a baby ?

Sadly, the reality is very different . The truth is that most IVF cycles fail, no matter how medically perfect they may be. This is something with which it can be hard to come to terms both for doctors and patients. The reason is simple - human reproduction is not very efficient – and this is true , whether you are making babies in the bedroom , or in the IVF lab ! After all, embryo implantation remains the final common pathway, and this is the major bottleneck for IVF success.

Of course , when you are trying to get pregnant in the bedroom , you don’t mind if it takes time ! Having baby-making sex can be quite an enjoyable exercise , which is why no one complains if it takes them 6 months to get pregnant ! And most fertile couples often forget about how long it took for them to get pregnantand that even though their January cycle was exactly the same as the February cycle and the April cycle, they didn’t get pregnant until August.

Most people are surprisingly ignorant about the human reproductive cycle , and unless you point out this fact , they forget that it takes time to make a baby in the bedroomafter all, it’s only in Hindi films that everyone gets pregnant the first night they have sex .

When we do IVF, we increase the chances of success in one cycle , as compared to natural intercourse , because we help the patient grow many eggs at one time. However, even though we can make many embryos in one cycle, we can’t control whether the embryo will implant or not after we transfer it into the uterus.

Embryo implantation is not something which we can either control or monitor , and that’s why we need to remember that the outcome of an individual IVF cycle is always going to be uncertain. This is why patients need to have realistic expectations , and accept the fact that it may take time before they get pregnant – whether they are trying in the bedroom, or whether they are doing IVF !

This is where the concept of a jackpot is so useful. Just like buying a lottery ticket is not compulsory , neither is doing IVF . Also, these tickets can be expensive, but are well worth it when you do win - and everyone buys one with the secret hope that they are going to hit the jackpot ! Finally, the chances of winning the jackpot increase with the number of lottery tickets you buy – and this is true of IVF as well. The more IVF cycles you do , the better your chances of getting pregnant , and the cumulative rate keeps on increasing , which is why it’s so important to have patience and perseverance.

Also, while we know that some people will win the lottery, it's impossible to predict who will, and when they will . This is true for IVF as well !

Want to increase your chances of hitting the IVF jackpot ? 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 !





Sunday, April 03, 2022

Stress does not cause IVF failure !



When an IVF cycle fails , patients are understandably upset , and demand answers for the failure, especially when the doctor told them at the time of transfer that the embryo was a top quality embryo, that their uterus lining was superb , and that their chances of getting pregnant were 90% (clearly a lie, but providing false hope is something which bad doctors resort to very often).

When their hopes come crashing down, they turn to their doctor for answers . Many doctors respond by blaming the patient for the failure ! They say the embryo did not implant because she was too stressed out, or because she did not rest enough !

This is a completely ridiculous and patently false answer , and the doctor resorts to this lie purely to protect himself ! After all, if stress caused IVF failure, then no IVF patient would ever get pregnant , because every IVF patient is under stress ! After all, who likes going to a doctor to make a baby ?

However , by blaming something intangible like stress, the doctor can deflect the blame , and refuse to intelligently discuss the causes of failure .

This is a very unkind form of victim-blaming. As it is, infertile patients suffer from poor self esteem , so when the doctor blames them for the IVF failure , she feels even worse about herself , and feels responsible for wasting all the money that was spent on the IVF cycle  !

I remind patients that it's not the stress that causes infertility - it is the infertility that causes stress ! After all, a woman who gets raped is under mind-numbing stress, but if she is going to get pregnant , nothing in the world is going to stop this biological process , which she cannot control with her mind .

If your doctor starts blaming you for your IVF failure by saying that you are too stressed out, then this is clearly a red flag, and suggests that you are dealing with an incompetent doctor.

The truth is that most IVF cycles will fail , and no one can predict which one will succeed and which one will not . There is absolutely no excuse for making a bad situation worse by blaming the poor patient for the failure .

Interestingly, it is usually incompetent doctors whose IVF lab isn’t any good, who resort to these dodgy tactics. It’s because their bad labs create poor quality embryos ( which is the real reason for the IVF failure) , that they are inclined to blame the patient , by hiding the truth from them, and refusing to share embryo photos.

Good doctors, on the other hand, provide photographs of embryos to all their patients routinely and proactively, to document the fact that the quality of care provided was excellent. They also counsel the patient , and remind them to have realistic expectations. After all, embryo implantation is not in either the doctor’s hands , or the patient’s , and we need to learn to live with grace and humbly accept this biological unpredictability.

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 !





Saturday, April 02, 2022

The commonest reason for IVF failure will surprise you !

 


Going through an IVF cycle can be very stressful , and especially when the cycle fails , your stress levels go through the roof . Patients want answers as to why the cycle failed, so they can do something different in the next cycle to increase their chances of getting pregnant.

There are many possible reasons for failure . Some of these are not in our control , such as the age of the wife. If she is old, there is a high probability that the quality of eggs will be poor, as a result of which the embryos will also be poor , and the chances of a pregnancy after transferring poor quality embryos are likely to be low.

However, the commonest reason for IVF failure is not bad eggs, bad sperm or a poor uterine lining ! A far commoner reason is poor quality embryos , and the most common reason for this is a poor quality IVF lab . This is because there is very little transparency, accountability, and openness in IVF clinics. They don’t bother about quality control, because they prefer to focus on quantity in order to maximise their profits. They often function as assembly lines, which treat patients as objects. In order to hide their incompetence, these labs refuse to provide patients with photos of their embryos .

Any clinic that refuses to do this is a bad clinic. After all, why do they want to hide this basic information from their patients ? Good labs are proud of the quality of embryos they create, and are happy to share this with their patients to document that they have received high-quality medical care.

The tragedy is that most IVF clinics in India don't share photos of embryos because they know that the quality of care that they provide is so poor , that the embryos they make are of poor quality, and they don’t dare share this bitter truth with patients .

Even though the commonest cause of IVF failures is poor quality embryos because of a bad IVF clinic, they get away with hiding this information . What’s worse, is that they add insult to injury by blaming the patient for the failure. They come up with all kinds of creative reasons, such as "stress," or "immune rejection," "sperm DNA fragmentation," "poor endometrial receptivity," or "genetic defects." By hiding the truth from the patients , they fool them into doing cycle after cycle at the same bad clinicoften after making them do expensive tests ( to extract more money), and subjecting them to even more expensive treatment ( such as "immune therapy") to extract even more money !

Sadly, because it’s the lab that is bad, the poor patients keep on getting the same negative result , cycle after cycle. After wasting a lot of time, money, and energy , they are so broken and disheartened, that they don’t have the courage to take treatment at a better IVF clinic .

These bad clinics cause a lot of harmnot only to patients, but to the reputations of all IVF clinics across the country.

Remember that the only way to protect yourself from this exploitation is to learn to protect yourself from these hacks, by insisting that they provide photographs of your embryos to you, If the clinic refuses to do this, this is a red flag , and you should run away from the clinic as fast as possible !

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 !


Wednesday, March 30, 2022

IVF patients can often be pennywise and pound foolish

 


Most patients who do their first IVF cycle have no idea what good IVF treatment looks like.  They mistakenly think that all IVF clinics are equally good and will give them the same level of medical care.They get lured either by the full page ads these clinics buy in newspapers ; and by the large roadside banners they pay for. These clinics often run "free IVF camps" to acquire patients . Every infertile couple who comes to the camps is advised to do IVF. The scam is that the tests are done by the clinic, and the results of these tests are always abnormal ! Patients are led to believe that the only solution to their problem is IVFand the clinic very kindly offers a discount if the patient signs up by paying an advance on the spot !

Most patients don’t know any better, and sign up, because they can see other patients signing up too , which is why these camps resemble the fairs that real estate developers organize, to sell their flats to customers.

Patients tend to focus on what they can see which is convenience, and price. They want to find a local IVF clinic that will offer them the lowest price package possible . Because these IVF clinics don't really care about quality , they are happy to offer "discount" packages which are surprisingly cheap on the face of it .

They do this because they routinely cut a lot of corners ! For example, they don't bother to do Day 5 ( blastocyst) transfers, and don't provide photographs of embryos to patients .

Patients don’t know what a good IVF clinic is supposed to do, as a result of which most of the cycles end up in failure. Not only do they end up wasting their money while trying to chase what seems to be a bargain , but what’s  even worse is they end up losing all hope .

In their short sighted quest to save money , they actually end up wasting it, and they deprive themselves of having a baby , because they are no longer willing to trust any other IVF clinic .

They ruin their chance of taking advantage of high quality IVF treatment, and end up hurting themselves in the long run.

Now this doesn’t mean that a clinic is good just because it is expensive ! Some of the busiest brand name clinics in the metropolises charge an arm and a leg because they need to pay huge kickbacks to the doctors who refer patients to them for IVF treatment.

The rule is simple: you need to do your homework before signing up at any clinic. IVF clinics should have to earn your trust – it’s too precious to be given away !

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Monday, March 28, 2022

How you can treat infertility because of sexual dysfunction at home using self-insemination

 


One of the commonest problems that prevents couples from having a baby is sexual dysfunction .

This includes male issues such as premature ejaculation and erectile dysfunction, as well as female issues such as vaginismus.

These are surprisingly common, but because these are taboo topics , they are not discussed, and even extremely well educated couples don’t know what they are suffering from.

This is especially a major issue with vaginismus , because they don’t know which doctor will be able to help them . Many gynecologists can be surprisingly unkind , because they don’t know how to treat this distressing problem.

Making the diagnosis of erectile dysfunction and premature ejaculation is easy - it's a self diagnosis after all. However, because of the psychological stress this causes , couples are often unwilling to seek treatment for this . For one thing , the man feels very ashamed , and the woman is reluctant to broach the topic because she doesn't want to hurt his feelings . As a result of this mutual conspiracy of silence, the problem festers, and they try to sweep the elephant in the room under the carpet, and they will often not even talk about this to their doctor unless he asks directly ( and most doctors fail to do this in a sensitive fashion, which means patients hide the truth).

The tragedy is that even though they may have completely normal fertility , they are not able to get pregnant . Sexless unconsummated marriages are surprisingly common, but because couples think they are the only ones having these issues , they don’t talk about it, which makes the problem even worse, because they don't know how to seek help and from whom.

Also, because it's such a touchy and sensitive issue, they are understandably reluctant to seek medical help ! 

If you take the time and trouble to do your homework , you will be able to determine what the problem is for yourself. While treating these problems can be surprisingly difficult and complex, because the underlying cause is psychological and not physical , the good news is that if your primary goal is to have a baby , it's possible for you to solve the issue by yourself by bypassing the problem and doing self insemination at home , which is simple , easy and inexpensive.

The even better news is that the pregnancy rates are extremely high , because there is no underlying fertility issue , especially if the wife is young !

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 !

Sunday, March 27, 2022

The dark dirty secret behind busy brand name IVF clinics

 


Most patients naively believe that busy IVF clinics which have a good reputation must be good because so many doctors refer their patients to these clinics for their IVF treatment.

However, the reality is very different .

Because they are so busy, these clinics often provide extremely poor quality care. Patients are treated like widgets on an assembly line, and their focus is to maximize their profits by treating as many patients as possible. They do many unnecessary and expensive tests, both before , during, and after the IVF cycle, so they can squeeze as much money out of the patient as possible.

However , they take so many shortcuts, that it makes my blood boil.

They routinely do Day 2 and Day 3 transfers, instead of blastocyst transfers, because their lab is not good enough, and their embryologist is not skilled enough. They do not provide any documentation, and insist on keeping the medical records with them, even though the Supreme Court has ruled that the medical records are the patient’s property. They refuse to share photos of embryos with patients, and will often transfer 3 or 4 embryos at a time , in order to maximize the chances of the patient getting pregnant and cover up their incompetence.

Not only does this mean that the patient has no spare embryos to freeze ( which means if the cycle fails, the patient has to pay money for a new fresh cycle, which is much more expensive than a frozen cycle), it also subjects the poor patient to the unnecessary risk of a multiple pregnancy . The doctor can then claim that the IVF cycle succeededand then charge even more money to do a selective foetal reduction in order to manage this iatrogenic complication ! Sadly, many of these patients end up miscarrying, and losing the entire pregnancy , which just adds further insult to injury .

The biggest tragedy is that these brand name IVF clinics continue to get away with this poor quality care, partly because there is no government regulation , but mostly because patients are completely clueless, and don't know what to expect .

They blindly trust that their IVF doctor is the best one, because their doctor referred them to the clinic, but the reason for this referral is not the competence of the clinic, but because these clinics provide the biggest kickbacks and commissions to the referring doctor ! These are the doctors who are often office-bearers of medical associations, and who throw parties for their referring doctors, to keep them happy.

IVF treatment is expensive and lucrative. As a result, most gynecologists and family doctors will refer patients to IVF clinics that give them the biggest kickback, rather than the best .

Most patients are completely clueless about what is happening in the background , and how much money is changing hands under the table .

If the clinic refuses to provide photographs of your embryos, this should be a red flag ! Also, any doctor who asks for cash payments and does not issue a receipt can’t be trusted. If he is willing to cheat the Income Tax Department , what's going to stop him from cheating you ?

Life used to be easier in the past , when people had a trusted family doctor , who was a part of the family. He had a long-term, lifelong relationship with his patients, and had a fiduciary responsibility towards them. He would send them to the best specialists , because he had their best interests at heart. Today , unfortunately , this entire relationship has become corrupted. As a result, the trusted family doctor has become a dying breed, as a result of which patients are helpless and vulnerable and get exploited all the time.

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 !

 

 

 

Tuesday, March 22, 2022

When can you start your next IVF cycle after IVF failure ?

 


A common question many patients ask is how soon they can start the next IVF cycle when the first IVF cycle fails .

It’s very hard to bounce back to normal when your HCG comes back as negative, because you had hope that your IVF cycle would work. After all, no one would start a cycle if they didn’t believe in their heart of hearts that this would be the one that would give them a deeply longed-for baby !

However, when your hopes get shattered, you no longer feel confident that IVF will ever work for you . You are extremely worried and anxious , and question whether you should start a second cycle or not . After all, if the first cycle failed, what is the certainty that the next one will work ? And how many will you have to do in order to be successful?

These doubts are completely normal , because everyone starts IVF , and expects to hit the jackpot in the first cycle itself. Even though their head understands the success rate is not 100%, in their heart they are sure that they are going to be one of the lucky ones, which is why they go to pieces when the cycle fails.

It takes time to recover emotionally from the failure of your first cycle , so please be kind to yourself, and give yourself time to grieve, so you can bounce back.

From a medical perspective, however , you can start your next cycle immediately , if that's what you want to do , especially if this was a frozen cycle , because your body goes back to normal immediately . After a fresh cycle , the doctor will need to do a scan on Day 2 to make sure that your ovaries are quiet before starting your treatment, - which could be another fresh cycle , or a frozen cycle .

Rather than worrying about whether it's medically fine to start again, you actually need to ask yourself: are you mentally prepared to start again ?

Some patients feel so sorry for themselves after the first failed IVF cycle that they just can’t muster the courage to go back to the IVF clinic to start another one . If that’s true for you, then please take a break , until you feel more optimistic .

On the other hand, many patients are eager to start the next cycle as soon as possible, because they know that sitting at home is not going to give them a baby. They would rather attempt a new cycle as quickly as possible , so at least they have something to look forward to, rather than brood about their failure.

The truth is that a second cycle is often much easier to do than the first cycle , because you've " been there , done that ", and you know exactly what's involved . Your anxiety levels in terms of treatment minutiae are much lower, and you have demonstrated that a failed IVF cycle is not the end of the world, that you are resilient, and that you can start over.

Uncertainty about the outcome will always be true for any IVF cycle, so the sooner you start again, the better your chances of having a baby sooner. If you are mentally prepared , there is no advantage to wasting time sitting at home , obsessing about your bad luck and feeling sorry for yourself !

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 !

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