How to bounce back after a failed IVF cycle

 

After an IVF cycle fails , the commonest question patients ask is – Why ?

This seems to be a simple, straight-forward question , given the fact that IVF failure is so common, but the answer can be surprisingly complex . This is because there are so many possible factors which affect embryo implantation , and it can be very hard for doctors to pin point what the exact causes are for an individual couple.

Unfortunately , rather than admit the truth to patients – that medical science doesn’t have all the answers - doctors often subject them to a whole battery of additional tests . Then, to add insult to injury, since some of these tests are bound to come back as abnormal ( even if they aren’t of any clinical importance), they propose additional invasive and expensive treatments , such as PGD, immune therapy, and ERA testing , and suggest to patients that this additional information will improve the chance of success in the next IVF cycle .

This is completely false , because more information does not increase pregnancy rates , simply because so much of this information is irrelevant, and just causes doctors to go down many rabbit holes, chasing expensive red herrings !

This is why it’s helpful to use a simple framework , so that you know what to do for your next cycle when the first one fails.

Start by simplifying, and breaking down the causes of IVF failure into two groups . One is stuff which you can do something about , and the other is all the rest, which you can't do anything about . For example, you can’t become younger, so if you are older , your ovarian reserve is likely to be poor , and you are likely to be a poor ovarian responder, no matter what protocol the doctor tries. It becomes very difficult for a doctor to fix this underlying problem,  because ovarian reserve is a biological fact of life, and the drop is irreversible.

The good news is that often the cause of IVF failure is something that can be fixed ! The commonest cause of IVF failure in Indian IVF clinics is a poor IVF lab – one that is poorly equipped, or that doesn’t have a full-time experienced expert embryologist.

The good news is that it’s easy to identify these bad IVF clinics – they hide information from patients by refusing to share photos of their embryos with them.  If your clinic doesn’t do this, it’s easy to identify that they are incompetent, and you need to find a better clinic – one that is open and transparent , respects their patients, 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

When sexual difficulties cause infertility - and how you can treat them at home

 

One would think that in this day and age , where everyone has free access to the internet, most adults would be very well informed about sexuality as well as fertility , but unfortunately, the number of myths and misconceptions in this space is mind-boggling.

In fact, the internet has exacerbated the problem of misinformation, because a lot of the " sex education " that teenagers get is through watching porn online. This misleads them , and they have a very distorted perception of the truth . An even bigger problem is that they don't even realize how little they know, as a result of which they continue to remain clueless .

Others get snippets of "facts" from friends, or advice from " aunties ", who don't know too much themselves, but think of themselves as being experts just because they have made a baby in their own bedroom.

This is one of the reasons why sexual problems such as premature ejaculation , erectiledysfunction, and vaginismus have become such common causes of childlessness.

These issues are swept under the carpet , partly because patients don’t know how to describe them; partly because they don't volunteer this information because they are ashamed; and partly because doctors don't have enough time or empathy to be able to ask questions about these sensitive issues to be able to get at the truth .

The problem festers, and becomes worse over time, because it is caused by psychological issues, and these become self fulfilling prophecies. The poor couple have absolutely no idea how to get out of this chakravyuh , and because it's such a touchy subject, they don’t have the courage to resolve it, because they don’t know how to find reliable information about this topic.

There are many quacks out there – both online and in the real world – who take these gullible, ignorant and vulnerable couples for a ride.

The good news is that these are extremely easy problems to solve , and you need to have the confidence that you can fix them for yourself in your own bedroom !

A very useful tip to remember is that you need to differentiate between baby-making sex, and having sex for giving each other sexual pleasure . If you try to combine the two , especially when you have sexual difficulties , you will just end up making the problem even worse !

These problems need to be solved one step at a time, and it can take time to solve psychological issues. This is why setting your priorities is so important. If getting pregnant is your primary goal, then you can use mutual masturbation to give each other sexual pleasure, and utilize self-insemination to get pregnantquickly. Don’t try to optimise making love with making babies at the same time – this will just waste precious time, and create more angst and frustration.

 Remember that there is no correlation between sexual pleasure and fertility – after all, even a woman who gets raped can get pregnant ! Making babies is  a simple biological process , and you shouldn't confuse orgasm, sex, and fertility !

The effect of the Roe ve Wade judgment, Reproductive Tourism and Indian IVF clinics

 

The US Supreme Court's decision to reverse the landmark Roe vs. Wade decision, which allowed women the right to legal abortion, has created a major crisis of confidence amongst educated American women . They are being deprived of their right to make their own choices once they get pregnant !

The problem is that the US is becoming an increasingly polarised society, and while the pro-choice vs. pro-life battle has always been a contentious issue , it is becoming increasingly clear that a society that today decides to curtail the rights of pregnant women may tomorrow decide to infringe on the rights of infertile women as well, and they may no longer be free to decide what they want to do with their frozen eggs and embryos . Thus, the US Govt may rule that frozen embryos are potential unborn babies, and cannot be discarded, and will need to be transferred into the woman’s uterus, whether or not she wants to get pregnant !

Sadly, activists, bureaucrats and judges don't seem to understand the difference between an embryo in the IVF lab and a fetus in the uterus !

The US Govt seems to take pride in telling women what to do , rather than giving them the freedom to make their own choices . A natural consequence of this will be a boost to reproductive tourism , and many American women who want to pursue IVF and make their own decisions as to what to do with their own frozen embryos will choose to do IVF outside the US.

India is going to be an extremely popular destination because the Indian IVF law respects the right of patients to do what they feel is right for themselves , and not force them to do what the Govt demands, depending on who happens to be in the majority in the US Supreme Court.

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