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 !

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 clinic – and 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 !

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 !

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 !

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 pregnant – and 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 bedroom – after 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 !

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 !

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 clinic – often 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 harm – not 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 !