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How to be a happy embryologist !

The 3 mistakes patients make when selecting an IVF clinic

 

1.  1. The commonest mistake is to blindly depend on their family doctor or GP or gynecologist to refer them to a clinic , because they hope and trust their doctor is a reliable source of medical information , and will act as a trusted get keeper and send them to the IVF clinic which has the best success rate . Once upon a time , this used to be true , but because of the rampant corruption which has infected the health care system today, often your family doctor will send you to the clinic which gives him the highest kickback , rather than the one with the highest success rate . This helps him to make more money, but reduces your chances of having a baby.

2.  2. The second problem is that they don't do their homework before selecting an IVF doctor . They automatically assume that just because their friend got pregnant in that particular IVF clinic , or because the clinic paid for a full page ad in the newspaper , or bought a press release or an award, that they are a good clinic. The reality is that not all IVF clinics are  the same . There is a world of a difference between the competence of clinics, and a huge gap between the success rates of good clinics and bad clinics . You need to do your homework before you select a clinic which is right for you,  and one simple way of doing this is by interviewing at least 2 clinics , creating a shortlist , and then choosing the one which you like the best .

3.   3. The third and most important mistake patients make is during their actual IVF treatment. They have absolutely no clue as to how their cycle is progressing . They are passive, and expect the doctor to inform them. The problem is the main doctor is never available , and they have to depend on either the assistant , or the nurse, which means they are completely in the dark . The point is you can’t select an IVF clinic based on your doctor’s referral, or its brand name or reputation – you need to be actively involved in making this critical decision, by investing in Information Therapy. The good new is that it’s easy to do this – all you need to do ( before starting your cycle !) is to confirm that the clinic routinely provides embryos photos to all their patients , and does only Day 5 transfers ( blastocyst transfers)

 

Why you should demand photos of your embryos

Demanding something from a doctor is unusual , because patients are meant to be docile and compliant, but the reality is that most IVF patients are completely clueless about IVF treatment, and sadly, bad doctors exploit their ignorance. They contribute to it by refusing to share information with patients and keeping them in the dark. Most doctors will take a very patronising attitude towards patients . The tell them that IVF is so complex that they won't be able to understand it , so there’s no point in wasting the doctor’s precious time by asking him questions , or even doing an internet search . Rather, a good patient should trust the doctor blindly, and leave everything in their capable hands .

This is fine if you happen to end up in a good IVF clinic , but the bitter truth is that the number of bad IVF clinics far outweigh the number of good IVF clinics , and if you can't differentiate between a good clinic and a bad clinic , you can end up in serious trouble .

The simple simple solution to this problem is to demand photos of your embryos, and good IVF doctors are happy when you ask for them, because they are open and transparent and take pride in the quality of medical care with they provide . They are happy to document this , because if they have made good quality embryos for you in their IVF lab, your confidence in them is going to increase . Also, this improves their professional reputation , because when you ask other doctors for a second opinion, they can confirm that the quality of medical care you received is good , based on the photos of your embryos.

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

Bad doctors, on the other hand , are in the business of hiding information , because they don't have confidence in the competence of their IVF lab . They will often lie to patients and tell them that their embryos are A grade or top quality , but without providing photographs to prove this , this statement doesn't actually mean anything at all .

This is why intelligent well-informed patients always demand embryo photos , and the right time to demand photos is before you start your treatment , by ensuring that the IVF clinic routinely provides photos to all their patients . This simple step will ensure that you don't get stuck in a bad IVF Clinic , and then regret your decision later on , because you ended up wasting your time , money and energy in a poor quality clinic.

Why you can't afford to be an IVF dummy

 

I talk to many patients who have failed IVF cycles,  and I am dismayed and perplexed by how little they actually understand about the IVF process , even though they are intelligent and highly educated professionals. They don't seem to have a clue about how many follicles they grew, how many eggs the doctor collected , how many embryos were transferred , or the quality of the embryos.

This is partly because IVF specialists refuse to share information with their patients. They want their patients to put them on a pedestal, and they keep their patients on their knees by telling them – Just leave everything up to me , because I am the IVF expert and I will do what is required . They treat their patients like dummies because it's much more convenient for them when patients blindly obey the doctor's orders !

In fact , these IVF doctors discourage patients from doing Google searches or finding out information for themselves . They tell patients that IVF is extremely complex , and that a doctor needs 10 years of training in order to master IVF, which means it’s just impossible for a patient to make head or tail of such a complicated medical treatment process.

Many patients get lost when trying to do a Google search to learn more about IVF because there is so much misinformation out there , and it’s not easy to judge which information is reliable and which is not .

However, if you don't know enough about IVF , it is very easy for bad doctors to exploit you. IVF doctors know infertile patients are gullible and desperate , which is why it’s so easy to cheat them .

However, you cannot afford to remain a dummy when you are doing IVF. You need to do your homework, both before starting the IVF cycle and during the IVF treatment, so you can ask the right questions and get the right information . Medical treatment is too important to leave everything up to the doctor , and good doctors will actually encourage you to find out as much information as possible for yourself , because they want you to have realistic expectations of what you can do for them. They know that the more you know about IVF, the lesser will be your stress levels, and the happier you will be with the quality of care they give you .

On the other hand, if you are completely clueless about IVF, you will not know whether the care has been good or bad , and if the IVF cycle fails because the doctor was bad, you will deprive yourself of your best chance of having a baby. Knowledge is power, and ignorance is not bliss, so please arm yourself with Information Therapy before starting an IVF cycle. 

You can do this free at www.drmalpani.com/IVFComicBook

Why transferring more than 1 embryo reduces pregnancy rates. More is not always better !

 

Many IVF clinics routinely transfer two or three or four embryos at a time to inflate their success rates, and often patients push their doctor to transfer more embryos because they think that transferring more embryos will increase their chances of having a baby.

This is actually very short sighted , and let me explain why .

While it’s true that transferring two embryos in one cycle has a higher pregnancy rate than transferring a single embryo in that cycle , this is actually comparing apples and oranges. Let’s suppose you have two top quality blastocysts. If you transfer both and don’t get pregnant, you need to start a fresh cycle , which is expensive and stressful . On the other hand, if you transfer one and freeze the other , you can then use the frozen embryo for your next attempt in case the first one fails, which is much less expensive. And if you do get pregnant with the transfer of a single embryo, you can keep your frozen embryo for your second baby ! This is why we tell patients that it's much more sensible and cost effective to transfer only one embryo at a time, because we are not wasting the spare embryos – we are freezing and storing them for you , and the success rate of freezing and thawing embryos is nearly 100% in a good clinic , thanks to the science of vitrification. In fact, the embryo implantation rate is higher with frozen embryos, because we can prepare the endometrium better, so that it’s receptivity is optimal.

Now if you transfer two embryos and both implant , you might think that this is a great outcome, because you have created an instant family, and got a bonus in the bargain – two babies for the price of one !

This is actually not true, because the complication rate with a multiple pregnancy is much higher than with a singleton pregnancy . You run the risk of miscarriage , and the chances of preterm labour are increased considerably, which means these premmies will often end up in a NICU ( Neonatal Intensive Care Unit ). They will often have lifelong problems because they were so small when they were born , and the biggest tragedy is that this is an iatrogenic problem – one created as a result of medical care, by transferring more than one embryo at a time.

When you need to decide whether you should transfer two embryos at a time with transferring a single embryo, you should compare the live birth rate with two embryos at one time with a single embryo at a time in two consecutive cycles . The cumulative ( overall) conception rate  with transferring 1 embryo and freezing the other one is actually better because freezing embryos has become a standardized process, and the implantation rates are higher in a frozen  cycle because it’s possible for us to prepare the endometrium  so it's optimally receptive.

If your doctors insists you transfer more than one embryo, this is a red flag, because this suggests he doesn't have enough confidence in the quality of the embryos his IVF lab creates. The best way to check the quality of your embryos is to demand by demanding photos of your embryos. This is standard clinical practice, and something which all good clinics all over the world do routinely and proactively. Remember that more is not always better !

Read our free IVF Comic Book at www.drmalpani.com/IVFComicBook

 

 

Knowledge Is Power for IVF patients

Many IVF patients are surprisingly clueless about their treatment . They naively believe that all they need to do is find an IVF Clinic , and then leave everything up to the doctor .

This is very simplistic, because it assumes all doctors are equally competent, and that all doctors have your best interests at heart .

The reality is very different .

Not only is there a wide variation in the technical competence of doctors, their bedside manners vary a lot as well, and many aren’t kind or empathetic, because they are too rushed and busy. Also, many IVF clinics are setup in order to maximize their profits , rather than care for patients .

This is why patients can’t afford to leave everything upto their doctor. Yes, it is very convenient to do so , but the reality is that ignorance is not bliss . Unfortunately , most patients learn this the hard way - only after their first IVF cycle fails. This is when they get up and finally start doing their homework . This is when it dawns on them that the quality of treatment they received was very poor , because the doctor did not bother to do a blastocyst transfer , and did not share photos of their embryos with them . Sadly, by this stage, the damage has already been done , because you have already paid your money up front . In fact, many clinics sign you up for a three-cycle package , which means you are stuck with that doctor , even if you have already lost all confidence in him.

What’s even worse is that your ability to trust any other IVF doctor takes a beating ! If you have been cheated by one IVF doctor, then it’s perfectly natural to assume that all IVF doctors are cheats. ? After all, why should any other doctor be any better than your current one ?

This is why so many patients who could have got pregnant if they had done IVF at a good clinic end up losing their chance of having a baby . And to add insult to injury , they end up wasting their hard-earned money on incompetent doctors.

Please make sure that you are yourself with Information Therapy before starting your IVF journey !

Check out the free IVF comic book at www.drmalpani.com/IVFComicBook