MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'in vitro'. Sat, 03 Sep 2011 02:00:44 +0100 http://www.medworm.com/index.php?rid=5181944&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fi-was-just-talking-to-patient-whose.html . She had had a poor ovarian response and he wanted to know whether it was worth trying another cycle again on not. His question was simple . Is it worth subjecting her to the pain of an IVF cycle ? Do we have a chance of success ? Or is it futile ? Are we just breaking our head against a brick wall . He wanted my opinion, based on what we’d learned from the first IVF cycle. He loved his wife a lot , and was very protective of her. He didn't want her to go through the pain of another IVF failure , and while he understood that there were no guarantees, he still needed advise as to whether it was sensible to try again. The major problem with an IVF cycle is not the physical pain of course - it's the emotional pain of failure, because there's so much riding on the outcome of an IVF cycle.... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5181944 Wed, 31 Aug 2011 04:03:00 +0100 5181944 http://www.medworm.com/index.php?rid=5181945&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fhow-to-do-consultation-3-step-approach.html I was giving an infertile couple a tour of our IVF lab. The husband was a cardiologist and he was marveling over how complex IVF is . He knows I am a big believer in Information Therapy, and he started wondering aloud how I could explain something so intricate, involved and complex as IVF in a 15 min consultation. I explained that I have a standard three-stage format for doing a consultation. In step number one , I explain normal fertility - how babies are made when everything is working properly. I review normal anatomy and physiology ; the role of the cervical mucus and the fallopian tubes; the concept of the fertile time; when ovulation occurs and how to track this; and the importance of frequent intercourse to maximize normal fertility. This is a review of the basics , just to make su... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5181945 Tue, 30 Aug 2011 04:19:00 +0100 5181945 http://www.medworm.com/index.php?rid=5174691&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fhow-to-do-consultation-3-step-approach.html I was giving an infertile couple a tour of our IVF lab. The husband was a cardiologist and he was marveling over how complex IVF is . He knows I am a big believer in Information Therapy, and he started wondering aloud how I could explain something so intricate, involved and complex as IVF in a 15 min consultation. I explained that I have a standard three-stage format for doing a consultation. In step number one , I explain normal fertility - how babies are made when everything is working properly. I review normal anatomy and physiology ; the role of the cervical mucus and the fallopian tubes; the concept of the fertile time; when ovulation occurs and how to track this; and the importance of frequent intercourse to maximize normal fertility. This is a review of the basics , just to make su... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5174691 Tue, 30 Aug 2011 04:19:00 +0100 5174691 http://www.medworm.com/index.php?rid=5174693&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fhow-do-i-decide-which-treatment-is.html Many infertile couples are confused as to which treatment to select. There seem to be so many choices – and even worse, so many different opinions from different doctors ! It’s hard for them to figure out if IUI is better for them ( as recommended by their gynecologist) or whether they should move on to IVF ( as suggested by their RE) ! This is why it's very important to create a comprehensive treatment plan right from the beginning . For example, I recently saw a young patient with polycystic ovarian disease . I sat with her and explained her options to her. Step number one would be ovulation induction with metformin , and if that didn't work, then we’d use ovulation induction drugs such as letrozole or clomiphene. If that failed, then one option would be laparoscopic ovarian drill... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5174693 Mon, 29 Aug 2011 03:14:00 +0100 5174693 http://www.medworm.com/index.php?rid=5159256&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fhow-lupron-and-gnrh-analogs-are-used.html Lupron is a GnRH Analogue. There are many other kinds of GnRH analogues available ,such as Lupride, Buserelin, Triptorelin ( Decapeptyl) and these all act the same way. As the name suggests, they mimic the action of GnRH. GnRH stands for Gonadotropin Releasing Hormone, which is a peptide ( a molecule which consists of a chain of amino acids) released by the hypothalamus. GnRH causes the pituitary gland to release the gonadotropin hormones, FSH ( follicle stimulating hormone) and LH ( luteinising hormone) . These GnRH analogues have a dual mode of action. When administered, they initially stimulate the release of gonadotropins, just like GnRH dose. However, when multiple doses are given, they cause the pituitary gland to switch off , so that it no longer produces any gonadotropins. This is... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5159256 Thu, 25 Aug 2011 03:42:00 +0100 5159256 http://www.medworm.com/index.php?rid=5159257&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fhow-antagon-and-other-gnrh-anatgonists.html In the past, most in-vitro fertilization (IVF) centres used pituitary down-regulation with gonadotrophin-releasing hormone (GnRH) agonists to prevent a premature LH surge and premature ovulation and luteinization. However, this required at least 7–14 days of GnRH agonist pretreatment. This is why researchers developed molecules which would cause an immediate blockage of the GnRH receptors on the pituitary gland, to stop the pituitary from producing gonadotropins instantly . This was felt to be a more rational approach , as these would induce instant downregulation , and prevent a spontaneous LH surge more effectively . Brand names of the GnRH antagonists include Antagon and Cetroride. Thus , treatment with the antagonist can be limited to only those 4-6 days when high oestradiol levels... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5159257 Wed, 24 Aug 2011 04:41:00 +0100 5159257 http://www.medworm.com/index.php?rid=5159259&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fwas-that-embryo-which-fell-out-after-my.html The mind plays games after the embryo transfer. Every little cramp or discharge can excite hope - or lead to despair ! This is especially true when the IVF cycle fails and patients get their menstrual period. They often imagine that they can see a little clot of tissue or a little ball of cells in the menstrual flow, and they feel that they have miscarried the embryo. This actually reinforces their feelings of low self esteem. Not only can’t they get pregnant in their own bedroom, their body could not even hold on to the beautiful embryos which the doctor grew in the lab and transferred to the uterus ! Please remember that an embryo is just a small microscopic ball of cells , which is not visible with the naked eye. If the embryo fails to implant , it gets silently reabsorbed about 2 o... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5159259 Mon, 22 Aug 2011 04:01:00 +0100 5159259 http://www.medworm.com/index.php?rid=5130843&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fhow-your-doctor-decides-dose-of-your.html When you do your IVF treatment, a very important decision the doctor needs to make is - What should your starting dose of HMG / FSH ( brand names for these key IVF meds include Repronex; Gonal-F; Follistim) be for optimal super ovulation? This is a key decision because this determines how many follicles you’re likely to grow. If he selects a dose which is too low , you may not have enough eggs or embryos. And if he selects a dose which is too high, you may grow too many follicles and end up with OHSS. We do have rules of thumb for this, but as with any biological system , it’s very hard to predict how a patient will respond finally, and we need to acknowledge that some of this is trial & error. As a general rule for most young patients, the starting dose is 3 amp of Menogon , whi... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5130843 Tue, 16 Aug 2011 03:42:00 +0100 5130843 http://www.medworm.com/index.php?rid=5107632&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fhow-to-get-more-patients-by-remaining.html MDConsult training tutorialView more presentations from Aniruddha Malpani.MDConsult is the world's largest online medical library - and Indian doctors can now subscribe to this at a highly discounted price.Check out http://www.thebestmedicalcare.com/mdconsult/to make sure you are always uptodate and well-informed ! (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5107632 Mon, 08 Aug 2011 03:39:00 +0100 5107632 http://www.medworm.com/index.php?rid=5096383&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fhow-to-improve-poor-uterine-lining.html One of the most frustrating problems in IVF today is the patient with a persistently poor ( thin) uterine lining.Normally, the endometrium should grow and become thick ( more than 8 mm) and trilaminar as the follicles grow, so that it is receptive and ready to accept the embryos when they are transferred into the uterine cavity.However, sometimes this does not happen.We do know that the growth of the endometrium depends upon:the estrogen level in the bloodblood flow to the uterusandthe health of the endometrial tissue itselfA problem with any of these will cause the uterine lining to remain poor.Thus, poor estrogen levels will cause the lining to remain thin. This is commonly seen in patients who have a poor ovarian response . It's easy to check this by testing the estradiol level in the b... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5096383 Fri, 05 Aug 2011 08:29:00 +0100 5096383 http://www.medworm.com/index.php?rid=5077801&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fwhat-happens-to-patients-who-do-ivf.html I received this email from a patient.I have edited it , but reading it still makes me cringe !My case details :- I am 32- My husband has slightly low motility (around 30% -including slow and rapid linears- during the best of times). However, doctors have always told us that since he has a decent sperm count, the motility is not something to worry.- We have been trying for a child for 4.5 years. We have tried on 7 clomid cycle and 1 letroz cycle. None of them were monitored. But i did check on OPKs. I always ovulated on the minimum dose of clomid.- I used to get my periods regularly (35 day cycle). But my cycle became irregular after we started to try for a baby. However, I still got my periods every 35-45 days-IVF Details:- I had my IVF done through NHS. However, it was a self-funded cycle... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5077801 Fri, 29 Jul 2011 14:46:00 +0100 5077801 http://www.medworm.com/index.php?rid=5069555&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fivf-science-and-pseudscience.html Medicine is not an exact science. It’s not possible for us to predict what the outcome of an IVF cycle is. While we are very good at making embryos in the lab, once we transfer the embryos into the uterus we still cannot predict which embryo will become a baby & which one won’t. When an IVF cycle fails , especially after the transfer of Grade A embryos, the first question the patient is going to ask is - Why did the cycle fail? When this happens , a lot of doctors become very defensive because they feel the patient is blaming them for the failure. This is why they are reluctant to tell the truth , which is - We really don’t know because we don’t have the technology to be able to answer this question. This is the honest scientific answer ! After all, human reproduction is an ine... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5069555 Wed, 27 Jul 2011 03:05:00 +0100 5069555 http://www.medworm.com/index.php?rid=5069556&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Feggs-are-not-follicles.html Many infertile women are very confused about the difference between follicles and eggsJust because they ovulate, they feel they much be producing good eggs every month.However this is not always true ! Women can have anovulatory cycles - and even ovulatory cycles may be the result of poor quality eggs !What about those women who are happy that their ultrasound scans for follicle tracking/ ovulation monitoring shows that they grow follicles every month ?While I agree this is reassuring, it does not mean that the egg quality is fine - especially in an older womanRemember that the follicle is only the black bubble which the sonographer can track during your scan. Normally, a good follicle ( one which grows at 2 mm per day and ruptures on Day 14 at the time of ovulation) does contain a good eg... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5069556 Tue, 26 Jul 2011 02:44:00 +0100 5069556 http://www.medworm.com/index.php?rid=5062317&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fis-it-egg-or-sperm.html Whenever an IVF cycle fails, the commonest question patients ask is - was there a problem with the eggs ? or with the sperm ?Logically, one would expect the answer to be 50-50 - after all, both are gametes which contribute the 50% of the DNA to the embryo.In fact, this is one of the reason there are so many tests for testing sperm "quality" - ranging from the zona free hamster egg penetration assay ( which is now obsolete) to the newer sperm DNA fragmentation tests ( which are very fashionable and popular right now, but will also soon get relegated to the dustbin).However, these tests are useless in clinical practise.Why do I say so ?Let's consider a couple who does ICSI treatment for a low sperm count, and gets poor quality embryos . They are disheartened and upset, so they get a second o... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5062317 Mon, 25 Jul 2011 02:46:00 +0100 5062317 http://www.medworm.com/index.php?rid=5057787&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fwhen-do-indian-doctors-create-their-own.html As compared to the USA, Indian doctors have been much more reluctant to go online to establish a digital clinic, and I find this surprising, since India is considered to be the IT powerhouse of the world !For many senior doctors, the web is still a very new tool - and they are not sure what value it will add to their lives . They have practised medicine happily for many years without the internet and are quite happy to continue doing so. For some, it's also the anxiety of having to learn a new tool - and unfamiliar technology creates its own barriers.Most senior doctors who are online have moved there for the following reason.1. Their colleagues and peers have their own websites , which is why they follow suit. This is especially true for highly competitive "fee for service" fields, such a... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5057787 Sat, 23 Jul 2011 02:34:00 +0100 5057787 http://www.medworm.com/index.php?rid=5050780&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fhow-vitrifying-ivf-embryos-helps-to.html Fresh or frozen embryos – which are betterView more presentations from Aniruddha Malpani. (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5050780 Mon, 18 Jul 2011 02:47:00 +0100 5050780 http://www.medworm.com/index.php?rid=5028518&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Ffinally-pregnant-after-frozen-et.html Here's a heartfelt success story from one of our patients.I think our journey to IVF started like for most couples. First, we got married and were perfectly content childless. Then, we started thinking about when to have kids and soon decided that “now” was the right time. After a few months, I started to read more and more on the internet about the fertile days, printed out ovulation calendars, and made temperature charts. Finally, I bought one of those electronic ovulation kits and invested quite some money in these gadgets. Well, but that still didn’t make me pregnant.My gynecologist said everything was fine, apart from two fibroids, but that shouldn’t matter. My husband, reluctantly, had his sperm tested and it seemed fine, too. So why did it not work?I tried a few rounds of cl... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5028518 Thu, 14 Jul 2011 02:55:00 +0100 5028518 http://www.medworm.com/index.php?rid=5028520&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fwhen-things-go-wrong-in-ivf-cycle.html There are lots of hopes riding on an IVF cycle - and every patient thinks in their heart of hearts that the cycle is going to work for them . This is why when something goes wrong, patients are often extremely upset and frustrated , and will often take out their anger both on themselves & on the doctor. Unfortunately IVF is a biological process and no matter how competent your doctor, sometimes bad things do happen. IVF obeys Murphy’s law which clearly states , Anything that can go wrong, will go wrong. This is why it’s important to be prepared and have realistic expectations. Every IVF cycle has multiple moments of truth. Think of it like a series of hurdles, and you need to cross all of these in order to reach the finish line. You can trip up on any one of these hurdles.Taking a ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5028520 Tue, 12 Jul 2011 03:02:00 +0100 5028520 http://www.medworm.com/index.php?rid=4975972&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fanother-happy-patient-from-malpani.html We had been married for 10 years. We had our careers, home, and friends everything going for us. Just one thing made us feel incomplete, especially me, not having a child of our own. Initially we felt it will happen after 6 months, a year. Then we took treatment. We had hopes. But all the hopes kept dying year after year. What was worst was when elders and relatives kept asking us about when we were planning to have a baby. That pressure was unbearable. But after 10 years I was coming to terms with the fact that I would be childless.We kept reading about the latest developments of science in this field in newspapers and kept tabs of the most successful doctors in the field. But we were afraid of the costs involved and that kept us from approaching them. But then we read some articles abou... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4975972 Tue, 28 Jun 2011 12:52:00 +0100 4975972 http://www.medworm.com/index.php?rid=4960135&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fhow-to-treat-paients-with-respect-guide.html This is a clever acronym !" Steps of RESPECTRespect – A respectful approach helps reduce defensiveness. “I appreciate how hard this has been for you…”Explanatory Model – Seeking patients’ explanations of their symptoms conveys an interest; presentsa starting point for discussions (not dismissals); and can promote patients’ forthrightness.“What do you think is causing your symptoms? Why?”Social Context – ‘Chit chat’ can promote comfort and provide insights into patients’ well-being.“How are you doing today?” “How’s work?” “How is the family?”Power – Resisting the impulse to take over and finding ways to share power can encourage patients tothink of themselves as partners in care, not consumers guided by the motto: Buyer Beware!“What would you like... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4960135 Thu, 23 Jun 2011 05:38:00 +0100 4960135 http://www.medworm.com/index.php?rid=4960137&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fis-success-rate-higher-with-fresh-or.html In the past, everyone agreed that the success rate was much higher with fresh embryos. This was primarily because the embryo freezing technology was not very good. We used a technique called slow freezing, and unfortunately, as a result of the freezing and thawing, upto 50% of embryos ( or the cells in the embryo) would die. This is because embryo cells ( called blastomeres) contain a lot of water; and the freezing process would lead to ice crystal formation within these cells. When these embryos were thawed, these crystals would cause cell death. Obviously, embryos will dead cells have a much poorer chance of implanting, and most labs were resigned to this fact that the process of freezing and thawing would cause damage to some embryos. However, it was still well worth freezing, because t... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4960137 Wed, 22 Jun 2011 02:20:00 +0100 4960137 http://www.medworm.com/index.php?rid=4953025&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fwhat-is-luteal-phase-defect.html Luteal phase defect ( LPD) used to be a very popular diagnosis many years ago. While most doctors today do not believe that this entity even exists, unfortunately, it’s still “diagnosed” commonly – and causes a lot of overtesting and overtreatment ! Let’s see why.The luteal phase is the second half of the menstrual cycle during which the corpus luteum produces progesterone to maintain the endometrial lining of the uterus so that an embryo can implant in it . At the time of ovulation, the mature follicle releases the egg . It then gets converted into a yellow body called the corpus luteum, under the influence of the luteinizing hormone ( LH) produced by the pituitary. ( Remember that it's this LH surge which is responsible for the ovulation !) If the embryo implants successfully, ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4953025 Tue, 21 Jun 2011 04:34:00 +0100 4953025 http://www.medworm.com/index.php?rid=4953026&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fwhy-were-my-embryos-of-such-poor.html While a good IVF clinic is good at making good embryos, sometimes we will encounter patients whose embryos are all of poor quality.What's a poor quality embryo ? This is one which divides slowly ( for example, one which has only 4 cells on Day 3) ; or one which has a lot of fragments. ( This is why you must ask your clinic for photos of your embryos, so you have documentation of the quality of your embryos ! )Why does this happen - and what can you do about it if it happens to you ?Remember that there are only 3 variables which influence embryo quality - eggs; sperm and the lab. This means that poor quality embryos could only be because of the 3 following reasons:poor quality eggs;poor quality sperm; ora poor quality labSurprisingly, experience has shown us that the sperm are not important... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4953026 Mon, 20 Jun 2011 04:00:00 +0100 4953026 http://www.medworm.com/index.php?rid=4953028&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fhow-to-improve-vitrification-of.html This is a guest post by our embryologist, Sai Gundeti.Vitrification is the newer alternative to the traditional ‘slow freezing’ technique of cryopreservation of embryos for storage and future use. It is far more efficient and effective than the older technique, which is why we now use only vitrification in our clinic for cryopreservation of eggs and embryos.It is the duty of the embryology team to learn this new technique, so they can offer the best possible care to their patients.Here’s how we vitrify embryos in our lab.It’s usually the supernumerary embryos which are vitrified, which is why embryo vitrification is generally carried out after the best ( top ) embryos have been transferred in the fresh IVF cycle . However, in some cases we may electively freeze all embryos , and no... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4953028 Sat, 18 Jun 2011 03:12:00 +0100 4953028 http://www.medworm.com/index.php?rid=4953029&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fwhat-is-empty-follicle-syndrome-why.html At the end of the egg collection, the first question every patient wants to know is - How many eggs did you collect, doctor ?Egg retrieval is usually a very straightforward procedure, and we usually get at least one egg from each mature follicle ( more than 18 mm in size) . This is why we expect to collect at least as many eggs as there are mature follicles . However, sometimes, much to the doctor's chagrin and the patient's dismay, sometimes we do not get any eggs at all. This is not common, but let's examine why this happens , and what we can do about it.Technically, if we do not collect any eggs at all , this condition is called " empty follicle syndrome( EFS) ". Sadly, this term is abused and misused by many IVF doctors, who are happy to make this "diagnosis" and blame this condition w... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4953029 Fri, 17 Jun 2011 03:26:00 +0100 4953029 http://www.medworm.com/index.php?rid=4934396&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fwhat-is-empty-follicle-syndrome-why.html At the end of the egg collection, the first question every patient wants to know is - How many eggs did you collect, doctor ?Egg retrieval is usually a very straightforward procedure, and we usually get at least one egg from each mature follicle ( more than 18 mm in size) . This is why we expect to collect at least as many eggs as there are mature follicles . However, sometimes, much to the doctor's chagrin and the patient's dismay, sometimes we do not get any eggs at all. This is not common, but let's examine why this happens , and what we can do about it.Technically, if we do not collect any eggs at all , this condition is called " empty follicle syndrome( EFS) ". Sadly, this term is abused and misused by many IVF doctors, who are happy to make this "diagnosis" and blame this condition w... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4934396 Fri, 17 Jun 2011 03:26:00 +0100 4934396 http://www.medworm.com/index.php?rid=4934397&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fis-my-ivf-doctors-treatment-correct-is.html As an IVF specialist, one of the commonest questions patients ask me is - Is my IVF clinic offering me the right treatment ? Are they using the right protocol ? Are they monitoring me properly ? Was the treatment which was offered to me correct ?This often puts me in a spot ! It's hard to know what another doctor did, without having complete and accurate documentation. This is why I do not like second guessing other doctors or commenting on their treatment, as every doctor does things differently !Sometimes I do cringe when I see how poorly the IVF treatment cycle was done . This is especially true when the treatment was done at a small clinic, which does less than 100 IVF cycles per year; or in a clinic which batches patients, and depends upon an IVF specialist who flies down once a month... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4934397 Thu, 16 Jun 2011 04:04:00 +0100 4934397 http://www.medworm.com/index.php?rid=4934399&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fwhy-patients-need-to-take-initiative.html I am always amazed by how smart some of my patients are ! While I am an IVF expert and know a lot about the technical minutiae of IVF, I do not know much about how to solve the additional challenges patients face when they need to travel to India for their IVF treatment. I am happily impressed by how well organised some of my patients are ! Travelling to India from the US for IVF treatment is quite a challenging exercise - but something they do with ease !What I like about these patients is that they take the initiative, thus making it easier for me to help them. For example, they will design their own IVF calendar ( using Excel or Word ), so it's easy for me to review and approve. This helps them to arrange their logistics efficiently - and makes it easier for me to OK their travel plans.... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4934399 Tue, 14 Jun 2011 15:54:00 +0100 4934399 http://www.medworm.com/index.php?rid=4911599&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fhappy-patient-from-kolkata.html Hi, We are from Kolkata and this is our story that we would like to share.First of all, would like to extend our warm gratitude to Dr.Aniruddha & Dr.Anjali Malpani, and their staff making our IVF treatment a SUCCESS !!!I am on the ninth week of pregnancy now and hoping and always pray it will be a SUCCESS until the baby is born.We tried 4 times IVF in Kolkata but every time we were disappointed, then from the website of Drmalpani we come to know about Dr Malpani.We were extremely happy by his instant response of all our queries by email . We reached Mumabi and went through the blood test where we found that my AMH level is low and we totally lost our hope. But Dr. advised us to go and take a chance with IVF and we followed his advise.And in my first attempt with him I got pregnant.The ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4911599 Thu, 09 Jun 2011 02:37:00 +0100 4911599 http://www.medworm.com/index.php?rid=4902502&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F06%2Fvery-pregnant-patient-from-us.html After three years of trying to conceive our first child (with efforts that included three rounds of Clomid with IUI, plus one un-medicated IUI) with some of the top infertility specialists in California, my husband and I were feeling sad, discouraged and borderline broke (our insurance didn't cover any infertility treatment), with still no baby in sight. We realized that IVF was the appropriate next step for us, but were daunted by the incredibly high costs in the US (our fertility center's rates start at $15K per cycle and can go up to $25K when taking on ICSI and other add-ons, but they couldn't tell you exactly how much it would cost until you were already committed to a cycle). We knew that giving up on our dream of having a family was not an option, but that paying upwards of $20K for... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4902502 Sat, 04 Jun 2011 15:21:00 +0100 4902502 http://www.medworm.com/index.php?rid=4829020&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F05%2Fdr-malpani-should-i-complain-about-my.html Every doctor wants to see his patients get better. After all, one of the major reasons people choose to become doctors is that they have a strong urge to heal and help others. Medicine is the ultimate service profession, and because it's a direct one-on-one relationship, good doctors devote a lot of their time and energy in keeping their patients happy.It also make a lot of business sense to do so. Patients who are happy are the best source of new patients ! Word of mouth marketing is the best was of growing a practise for doctors , and doctors understand the value of this.This is why happy patients make for happy doctors !Unfortunately, not every patient is going to do well. Medicines do not always work and the human body can be fickle. This is especially true in IVF cycles, when the outc... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4829020 Mon, 16 May 2011 02:35:00 +0100 4829020 http://www.medworm.com/index.php?rid=4803258&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F05%2Fafter-ivf-2-ww.html We normally do a blood test for HCG 2 weeks after the embryo transfer to find out if the embryos have implanted and if the cycle has been successful or not.This can be a very long 2 weeks , and many women will start doing pregnancy tests 5 days after the embryo transfer.The problem is that even if the embryo has implanted and you are pregnant, the embryo produce such small quantities of HCG for the first few days after it implants ( remember that it's just a microscopic ball of about hundreds of cells or so at this time), that it's not possible to detect this HCG in the blood . To be able to detect the HCG in the urine will take even more time, which is why you need to be patient.Of course, many patients will cheat :) - and this is an email I got from a patient today. A picture is worth a ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4803258 Tue, 10 May 2011 12:37:00 +0100 4803258 http://www.medworm.com/index.php?rid=4758804&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fwaiting-for-doctor.html This is a guest post from a very thoughtful patient of mine. I know many IVF patients will be able to identify with her experience . I just wish more doctors would read this as well, so they can provide more support to IVF patients !When you do ivf as a medical tourist soon you'll find out you have become a traveller between the worlds. Between continents and between medical worlds: "normal" obstetrics and ivf. Unexpectingly it turns out to be much easier finding an ivf doctor in India than finding an obstetric gynecologist in your home town. And once you are lucky enough to get an appointment, you are faced with different treatment concepts: pregnancy in obstetrics and pregnancy in ivf are a world apart it seems. Unless you are already established with an ob gyn - not so likely; you would... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4758804 Thu, 28 Apr 2011 04:50:00 +0100 4758804 http://www.medworm.com/index.php?rid=4734247&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fpgd-cgh-is-it-of-any-use.html The newest IVF technology uses a fancy new technique which marries IVF and genetics. This is called PGD ( preimplantation genetic diagnosis) with CGH ( comparative genomic hybridisation) and there are lots of press releases and articles touting this as the newest breakthrough !Doctors , like all big boys, love to play with new toys - and the newer the better ! This is especially true when they have expensive new technological tools, which no other competitor has. Doctors can be very competitive - and are always trying to be one-up on each other. An easy way of being different is to use the newest technology - but the trouble is that never is not always better ( though newer is always more expensive !)Because these new tools are so expensive , doctors need to use them extensively, to justif... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4734247 Tue, 19 Apr 2011 02:45:00 +0100 4734247 http://www.medworm.com/index.php?rid=4723979&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fpreparing-for-worst.html I always tell me patients to prepare for the fact that their IVF cycle may fail. Many patients dislike this. They feel I am being too negative - and are secretly worried that such negative thoughts are a jinx which will jeopardise the outcome. Most patients want a cheerful optimistic doctor who will promise them a baby.Intelligent patients appreciate my honesty and frankness - they prefer a doctor who will tell them the unvarnished truth. Others who cannot handle the truth will usually move on to another doctor who is willing to promise them the moon - and who is happy to tell them what they want to hear !It's very easy to smile; be optimistic - and make false promises. Everyone wants to think positive - and if you believe the book The Secret, then positive thoughts attract success !While ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4723979 Mon, 18 Apr 2011 03:13:00 +0100 4723979 http://www.medworm.com/index.php?rid=4723980&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fwhy-i-love-being-online-ivf-specialist.html This is a guest post from Carina Freeman, the Fertility Coach. I think it's time to take the time and share my story. To help you understand why I am passionate about Hold your Hand fertility coaching. In 1997 I was able to conceive a son with no problems at all. I had no idea what my future would hold. I have always had very severe menstrual cramps. However, I never went to get them checked out because I thought it was "normal." My mom, her sisters, and their mom also had severe cramps. I always wanted more children after my son was born in 1997, but thought maybe it just wasn't my time yet. So, we kept trying for years with no success. This made me feel like less than a woman. Why could I not give my husband a child? After several years, my husband suggested I go to the doctors to ha... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4723980 Sun, 17 Apr 2011 09:55:00 +0100 4723980 http://www.medworm.com/index.php?rid=4719949&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fi-have-low-amh-level-what-should-do-i.html For older infertile women, AMH ( anti-Mullerian hormone, also known as MIS ( Mullerian inhibiting substance) has become the new FSH . AMH is a very good marker for egg quality - and provides us with a quantitative measure for egg quality and quality.In the past, we had to depend upon FSH levels. A high FSH level suggests poor ovarian reserve, but FSH levels are not very reliable, because they vary according to which day of the cycle the test is done; and can also be artificially suppressed by a high estradiol levelAMH is a much better marker for ovarian reserve. It does not vary from cycle to cycle; and remains the same throughout the cycle. A low AMH suggests you have poor ovarian reserve - but even if your level is low, this does not mean you should panic !Remember that it's just a test ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4719949 Sat, 16 Apr 2011 03:28:00 +0100 4719949 http://www.medworm.com/index.php?rid=4714843&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fdoctors-patients-internet-information.html “What can you possibly learn from your doctor that is not available on the Internet?” We suspect we'll hear such radical sentiments increasingly in the future. Knowledge is said to be power, and some of the past imbalance of power between patient and doctor may be equalized. But information and knowledge do not equal wisdom, and it is too easy for nonexperts to take at face value statements made confidently by voices of authority. Physicians are in the best position to weigh information and advise patients, drawing on their understanding of available evidence as well as their training and experience. If anything, the wealth of information on the Internet will make such expertise and experience more essential. The doctor, in our view, will never be optional."Actually, there are some thi... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4714843 Thu, 14 Apr 2011 17:11:00 +0100 4714843 http://www.medworm.com/index.php?rid=4704734&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fhappy-couple-from-canada.html Hi, We are from Canada and this is our short story that we would like to share as noted below:First of all, would like to extend our warm gratitude to Dr.Aniruddha & Dr.Anjali Malpani, and your staff making our IVF treatment a SUCCESS !!!I am on the eleventh week of pregnancy now and hoping and always pray it will be a SUCCESS until the baby is born.Planning/deciding to undergo IVF is not a joke/easy. There are a lot of things to consider.1. Financial - IVF involves a huge amount of money like travelling expenses, hotel,food,medicine and might affect the job as well2. Stress - Need to manage your stress - IVF involves a lot of stress. 3. Taking the risk a. Job - Ready to quit the job to have full rest if required according to case to case basis before and after the treatment until... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4704734 Tue, 12 Apr 2011 03:12:00 +0100 4704734 http://www.medworm.com/index.php?rid=4684461&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fbleeding-during-ivf.html One of the most difficult things IVF patients have to deal with is the fact that there are no external symptoms or signs of what’s happening inside their bodies. Are the follicles growing well ? Is the uterine lining maturing properly ? Are you responding well to the medications ? Are the eggs of good quality ? Are the embryos implanting ? An important marker of the reproductive cycle is bleeding – and this can become a major source of stress during an IVF cycle !The start of the menstrual period is an event most IVF patients look forward to, because finally the IVF cycle is ready to commence – and you are now ready to take your best shot at having your long desired baby ! You are all pumped up and ready ! You’ve spent a long time waiting for your treatment to begin ( with waiting ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4684461 Wed, 06 Apr 2011 03:01:00 +0100 4684461 http://www.medworm.com/index.php?rid=4676888&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fmind-games-during-ivf.html For many patients, the emotional stress of going through an IVF cycle is far more than the physical stress ! The overriding fear is that of failure – what will I do if the cycle fails ? Will life be worth living ? They understand that IVF is the one treatment option which maximizes their chances of having a baby and have pinned all their hopes and dreams on the cycle succeeding. They dread to entertain the possibility of failure , as a result of which they are emotionally very vulnerable.Even before starting the IVF cycle, they spend a lot of time and energy doing their homework. Some will do their research and become an expert on IVF; others will doctor shop; while some will go to a temple to make sure God is on their side !While there are quite a few ups and downs during the moments of... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4676888 Tue, 05 Apr 2011 02:58:00 +0100 4676888 http://www.medworm.com/index.php?rid=4676889&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fivf-treatment-hope-for-best-and-prepare.html I always tell my patients to prepare for the fact that their IVF cycle may fail. Many patients dislike this. They feel I am being too negative and are secretly worried that such negative thoughts are a jinx which will jeopardise the outcome. Most patients want a cheerful optimistic doctor who will promise them a baby.It's very easy to smile and to make false promises. Everyone wants to think positive - and if you believe the The Secret, then you also believe that positive thoughts attract success !While I am personally very optimistic by nature, I feel it's not correct for a doctor to overpromise success ! Patients are emotionally very vulnerable and it's easy to take them for a ride - something which many unscrupulous IVF doctors do all the time, by quoting inflated success rates and prom... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4676889 Mon, 04 Apr 2011 02:34:00 +0100 4676889 http://www.medworm.com/index.php?rid=4670183&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fwhat-to-do-when-you-make-mistake.html I see many patients who have failed IVF cycles in other clinics. In order to improve their chances of success, I ask them basic questions about their earlier cycle: How many follicles did you grow ? How many eggs were retrieved ? What was your embryo quality ? Surprisingly, many are quite clueless , and know very little about the medical details of their treatment cycle, because " my doctor did not tell me anything " ! They are often upset and angry- and resentful that their doctor did not share more information with them.After realising how much their doctor has kept them in the dark, they conclude that they made a mistake in the doctor they selected. They feel cheated and start believing that they can no longer trust any doctor.One of the reasons for their bad choice is because they did... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4670183 Fri, 01 Apr 2011 14:28:00 +0100 4670183 http://www.medworm.com/index.php?rid=4664287&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fwhat-to-do-when-you-make-mistake.html I see many patients who have failed IVF cycles in other clinics. In order to improve their chances of success, I ask them basic questions about their earlier cycle: How many follicles did you grow ? How many eggs were retrieved ? What was your embryo quality ? Surprisingly, many are quite clueless , and know very little about the medical details of their treatment cycle, because " my doctor did not tell me anything " ! They are often upset and angry- and resentful that their doctor did not share more information with them.After realising how much their doctor kept them in the dark, some of them feel they made a mistake in the doctor they selected. They feel cheated and start believing that they can no longer trust any doctor.This is not a happy situation, because they then lose the opport... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4664287 Fri, 01 Apr 2011 14:28:00 +0100 4664287 http://www.medworm.com/index.php?rid=4636491&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F03%2Fhow-many-weeks-pregnant-am-i.html Many IVF patients get very confused about how the doctor calculates the age of their pregnancy( = gestational age, in medical jargon). Logically, shouldn't it be from the day of the embryo transfer ? After all, it's only after the embryos are transferred that a woman can be considered to be pregnant !However, doctors are not always logical, and we usually use the menstrual age when talking about the length of the pregnancy. This is because obstetricians usually see women who have got pregnant after having sex in their bedroom. Very few of them will know the exact date they ovulated , which is why we use the menstrual age in clinical practise. This does not change just because you have had an IVF pregnancy - the clinical rules remain the same !This creates a lot of confusion in patient's mi... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4636491 Sat, 26 Mar 2011 03:47:00 +0100 4636491 http://www.medworm.com/index.php?rid=4636495&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F03%2Finfertility-mans-perspective-ivf.html We were a happy carefree couple, enjoying our freedom to do things that we liked, for the first four years of our marriage. And then when we finally thought of starting a family…. It didn’t happen for another year and we were happy childfree couple. Couldn’t figure out initially what can go wrong, but when we decided to do a reality check, we landed up at a neighborhood Obs&G’s clinic. She ran a few preliminary tests which didn’t point to anything in particular, prescribed few medicines for me. Six months later, the same tests were repeated again, and again. And then I was referred to a urologist for surgery for a suspected varicocele. That’s when it dawned upon us that may be we are knocking on the wrong door!After a couple of months & a million clicks on the net, we d... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4636495 Thu, 24 Mar 2011 03:21:00 +0100 4636495 http://www.medworm.com/index.php?rid=4636505&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F03%2Fsperm-dna-fragmentation-assessment-is_17.html All infertile couples know that the sperm plays a vitally important role in fertility. However, there's still a lot of confusion ! If we need only one sperm to fertilise an egg during ICSI, does the sperm count and motility really matter ? And if it does, how and why ?The fact that the WHO has kept on changing the definition of what a normal sperm count just testifies to the fact that experts are as confused as patients are. This is especially true when we consider 3 contentious areas. While it's true that the sperm provides 50% of the child's DNA, can it be responsible for:failed fertilisation after ICSI ?poor qualty embryos ?miscarriages ?In order to drill down further into when the sperm can be responsible for reproductive problems, researchers have developed sophisticated tests to anal... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4636505 Thu, 17 Mar 2011 03:46:00 +0100 4636505 http://www.medworm.com/index.php?rid=4636511&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F03%2Fvalue-of-clomiphene-citrate-challenge.html Many older infertile women are very unsure as to whether they need to do IVF; and if they do need IVF, if they should use their own eggs or to use donor eggs. While they understand with their heads that using donor eggs would maximise their chances of getting pregnant, it's hard for their heart to accept this decision, because most of us want a genetic link with our child !This is especially true for older women who have regular cycles; grow follicles on ultrasound scans ; or have had a miscarriage in the last 2-3 years. If my cycles are regular and I can get pregnant in my own bedroom, doesn't this prove my eggs are fine ?Gynecologists ( who do not specialise in infertility treatment) will often add to this confusion. Because they see 42 year old women who get pregnant in their own bedroo... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4636511 Tue, 15 Mar 2011 04:14:00 +0100 4636511 http://www.medworm.com/index.php?rid=4636514&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F03%2Fthanks-dr-malpani.html This is an email a patient from Nigeria sent me today." I have set aside this morning to commend you and your beautiful wife on the good work you are doing for humanity. You give hope to the hopeless, healing our wounds of years by showing commitment and concern, even when the situation looks gloomy. You are ready to even pray for mercy and help for your patients! I am impressed.I have discovered that IVF is a journey. The travellers are the patients, but all of us will have to travel by different means of transportation, The luckiest by air, some by sea, others by road. It means there will be travellers by jet, speedboat, canoe, ships, cars, bikes, rail or even trucks and cartwheels! I am happy you guys are the drivers and my prayer is that the Almighty Creator will always grant you the w... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4636514 Sun, 13 Mar 2011 13:41:00 +0100 4636514 http://www.medworm.com/index.php?rid=4636515&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F03%2Fmoments-of-truth-in-ivf-cycle.html An IVF cycle is full of uncertainty and suspense , like any other biological system. However, being prepared for these can help you cope better !Think of an IVF cycle as being a series of hurdles - and you need to cross all these to reach the finish line ! While most patients will cross these hurdles with ease in a good IVF clinic, each of these is a " moment of truth ".You should grow many folliclesThese follicles should matureYour uterine lining should also mature in synch with your folliclesOvulation should not occur before the eggs can be collectedMature eggs must be retrieved by the doctor during the "pick-up"Your sperm must fertilize the eggs ( with IVF or ICSI)The embryos must divide and grow healthily in the IVF labYour embryos should be transferred by the doctor smoothly into your... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4636515 Sat, 12 Mar 2011 03:35:00 +0100 4636515 http://www.medworm.com/index.php?rid=4570602&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Fwhy-we-offer-guaranteed-pregnancy.html Everyone knows IVF has a limited success rate and that there are no guarantees in medicine. If that's the case, then why do we offer an IVF guaranteed pregnancy program ?Is this just a marketing gimmick ?No ! There are lots of benefits to this option, both for our patients and for us.For one thing, this option bolsters the patient's confidence levels ! Patients who have failed IVF cycles elsewhere have lost confidence in doctors - and in themselves. Before starting the IVF cycle, most clinics promise the moon. However, when the cycle fails, the patient becomes a leper and the doctor becomes inaccessible ! Finding a doctor who is is willing to put his money where his mouth is helps them to rebuild confidence in the medical system !This option also helps patients to have realistic expectatio... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4570602 Fri, 11 Mar 2011 03:56:00 +0100 4570602 http://www.medworm.com/index.php?rid=4570603&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Fspringtime-in-mumbai-ivf-success-story.html My husband and I have been married for seven years, and are now 11 weeks pregnant! Even with the euphoria of this moment I don’t want to forget the journey of three years that brought us here, and Dr. Malpani and his team have been like a guiding light in this.The ‘TTC’ CoupleWe wanted the first few years of our marriage for ourselves and made the most of them by traveling all we wanted, my establishing myself in my career and having time with each other. After the fourth year we started trying for a baby, once the initial 7-8 months were over we started to think that we should get a medical opinion so that we can eliminate the possibility of a problem or rectify it if there’s one. We met our OB&G and she suggested a few basic tests, based on these she started some medication f... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4570603 Thu, 10 Mar 2011 09:10:00 +0100 4570603 http://www.medworm.com/index.php?rid=4566165&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Fis-doctor-professional-or-technician.html I just saw a patient who was 40 years old; she had had 2 miscarriages; and she wanted me to do surrogacy for her. I spent a long time explaining to her why I did not think this was her best choice. Surrogacy is an expensive and complex treatment option, which is best reserved forwomen without a uterus. Research shows that the reason for failed implantation is much more likely to be genetically abnormal embryos ( because of poor quality eggs), rather than a uterine problem.Her reasoning was completely different. The fact I got pregnant means my eggs are OK ! The fact I miscarried means my uterus is defective because it could not hold the baby. This means that if use a surrogate uterus, I will have a baby !The reality is completely different. The fact that she conceived means her uterus is f... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4566165 Thu, 10 Mar 2011 04:26:00 +0100 4566165 http://www.medworm.com/index.php?rid=4566169&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Fatlas-of-ivf-embryos-dr-sai-senior.html Unfortunately, most patients doing IVF treatment are quite clueless about the most important end-result of the IVF cycle - the embryos ! This atlas will help you understand what your eggs and embryos should look like, so you have a better understanding of what happens in the IVF lab !DAY 0 ( the day of egg collection)MATURE OOCYTE CUMULUS COMPLEXESTHESE ARE MATURE OOCYTE CUMULUS COMPLEXES, IDENTIFIED IN THE FOLLICULAR FLUID ASPIRATED DURING EGG COLLECTION.POST MATURE OCCYTE CUMULUS COMPLEXSTRIPPED EGGSMATURE EGGS :THIS IS A MATURE EGG (SURROUNDING CUMULUS CELLS HAVE BEEN STRIPPED OFF)POLAR BODY AT 12 O CLOCK POSITION INDICATES THAT THIS IS A MATURE EGG AT METAPHASE IISTRIPPING IS MANDATORY FOR PERFORMING ICSI ON THEM.CUMULUS NEED NOT BE STRIPPED FOR CONVENTIONAL IVF.THIS EGG IS NOT A MATUR... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4566169 Wed, 09 Mar 2011 06:44:00 +0100 4566169 http://www.medworm.com/index.php?rid=4554662&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Ftry-and-try-till-you-succeed-success.html Try and try till you succeed....i think this mantra holds not only in your professional life but personal too....After two years of trying for baby and undergoing two laproscopies ,two iuis and one failed ivf we were devastated....we thought we can never have a child of our own....but then by God's grace we came across the web site of Dr Malpani..Oh it was so informative! i posted my history and there came a very positive reply..there was a ray of hope...we made up our minds to give ourselves one more chance so that we don't repent later.We visited Dr Malpani clinic in May 2009 for the first time and i must say there is something in his clinic..i think its God's blessing to them...the environment is so positive and cordial and Dr Malpani is so very approachable and positive too that we imm... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4554662 Sun, 06 Mar 2011 11:45:00 +0100 4554662 http://www.medworm.com/index.php?rid=4549791&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Fwhat-can-i-do-to-improve-chances-of-my.html This is one of the commonest questions patients ask me. A good IVF clinic is quite good at making good embryos in the lab. However, once they are transferred into the uterus, then whether they will implant to not is a biological process which is not in anyone's control ! It can be quite scary to think that the fate of your embryos is in your hands - and that if you make a false move, you may lose the embryos !The actual IVF treatment, leading upto the egg collection is full of action ! You are taking injections every day and the doctor monitors you closely. It's fun watching your follicles grow on the ultrasound screen and actually seeing your embryos can be a very emotional moment in your life ! However, after the embryos are transferred, you are pretty much on your own. You have no idea ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4549791 Sat, 05 Mar 2011 05:16:00 +0100 4549791 http://www.medworm.com/index.php?rid=4545024&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Fovertested-and-overtreated.html Infertile patients can be desperate for a diagnosis. They naively feel that once they know what the problem is, we'll be able to find the solution !This leads to testing - which has now become an epidemic of overtesting.Let's see why. Patients still have unrealistic expectations from IVF treatment. Doctors often do not bother to counsel them. They are so focused on "grabbing patients" to do one IVF cycle, that they overpromise success. They make tall claims during the IVF cycle to keep the patient's hopes high - everything is going very well- you will definitely get pregnant ! Then, when the cycle fails, the doctor becomes inaccessible ! Patients get disillusioned and hunt for a new doctor. The new doctor needs to do something more - something different - as compared to the old one - after... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4545024 Fri, 04 Mar 2011 04:49:00 +0100 4545024 http://www.medworm.com/index.php?rid=4540601&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Fwhat-is-minimum-number-of-follicles-you.html We deal with a number of difficult patients who have failed multiple IVF cycles elsewhere. Many of these are poor ovarian responders and a common question is - How many follicles do you need to go ahead with the treatment ? Is there a number in your clinic below which you will cancel the cycle ?These patients suffer from a lot of anxiety and apprehension during the superovulation, because they know they are not likely to grow many eggs. They have already had many of their cycles cancelled in the past - and this can be quite a cruel thing to do , because these are eggs which they have produced with a lot of effort ! Their eggs are precious - and represent their best chance of their having a baby with their own genes. This is why when the doctor cancels the cycle because they have not produc... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4540601 Thu, 03 Mar 2011 03:26:00 +0100 4540601 http://www.medworm.com/index.php?rid=4536150&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Fdonor-embryos-and-embryo-adoption.html Donor Embryos: Biologically , embryo adoption is exactly the same as a traditional adoption , in that the child and the parents have no genetic linkage. However , here the resemblance ends. Whereas with traditional adoption it is a child who is adopted after birth, in embryo adoption the infertile couple adopts an embryo before pregnancy.However , the sad tragedy is that there are just not enough babies available for adoption. Not only is the demand for adopting babies increasing day by day as infertility becomes more prevalent , the supply of unwanted babies being put up for adoption by the mother has become drastically reduced.It is ironic that while the technology of contraception and abortion has reduced the availability of adoptable children, assisted reproductive technology now offer... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4536150 Wed, 02 Mar 2011 05:00:00 +0100 4536150 http://www.medworm.com/index.php?rid=4536151&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F03%2Fwhat-ever-you-say-doctor.html At the end of a consultation, I usually ask my patients - So what have you decided ? What would you like to do next ? After all, IVF is an elective treatment; and infertile couples have many choices. These are very personal decisions, which are best made by the couple themselves, rather than the doctor.Often, many patients will answer - Whatever you say, doctor !While it may seem very flattering that they are willing to allow me to make the decision for them, this is actually not a good answer , and I am unhappy when I hear this !I'd much rather have a patient who took the time and trouble to understand their options, so they could make the decision for themselves . The best decision is one you make yourselfI will not let them make the wrong decision - but when there are choices, patients ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4536151 Wed, 02 Mar 2011 03:30:00 +0100 4536151 http://www.medworm.com/index.php?rid=4532274&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fhappy-patient-from-europe-who-did-donor.html I am the classic case of a woman who postponed starting a family to focus on her career while never believing that one day she would be facing infertility issues. I even believed that I could choose the month I wanted to get pregnant! I was almost 34 years old by the time my husband and I were out of school and settled enough in our jobs to start our family. I guess that is not really so old if there are no fertility issues, but if there are then time is definitely not on your side. By the time I turned 35 years old, we were living in Europe and began seeing a infertility specialist. In the middle of all the standard infertility tests, I managed to fall pregnant naturally. Our joy did not last long because at 8 weeks pregnant all that could be seen on the ultrasound were two empty gesta... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4532274 Mon, 28 Feb 2011 13:11:00 +0100 4532274 http://www.medworm.com/index.php?rid=4525061&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fdoes-it-matter-how-many-ivf-cycles-you.html We see many patients who have failed multiple IVF treatment cycles in other clinics. Most of them are quite depressed and frustrated. They are not sure whether it's worth trying another IVF cycle with us, or whether they should explore alternative options .The key question in their mind is - What can you do differently from the other IVF clinics ? What makes you better ?I enjoy treating these patients . For one, they are a challenge, and if our treatment works where other clinics have failed, this is a feather in our cap ( doctors can be very competitive !)Also, because they have done IVF earlier, they understand the basics of the treatment, so I can have an intelligent conversation with them and explain what we are going to differently. Because we are a full-service clinic, we can offer a... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4525061 Sat, 26 Feb 2011 04:47:00 +0100 4525061 http://www.medworm.com/index.php?rid=4522160&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fmaking-sense-of-your-ivf-superovulation.html One of my patients recently asked me - Which protocol is better for IVF - the Letrozole Antagonist Protocol vs the Estrogen Priming Protocol ?( In passing, I'd like to point out how impressive it is that patients are so well informed about medical minutiae ! Most gynecologists are quite unaware of all these finer details !)Actually, the principles of any superovulation protocol for IVF are extremely simple. Superovulation forms the heart of modern IVF. We use medications to help you grow more eggs. Every month you start to grow about 30-40 follicles, but in a natural cycle, most of these undergo atresia (die), so that only one matures every month, in the normal course of events. With the help of medications, we are able to rescue follicles which would otherwise have died, so that we can he... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4522160 Fri, 25 Feb 2011 04:41:00 +0100 4522160 http://www.medworm.com/index.php?rid=4501648&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fis-advise-just-be-positive-useful-for.html Everyone loves advising infertile couples ! ( After all, if they've had a baby in their bedroom and proven their fertility , this makes them fertility experts, right ? )The commonest advise is - Just relax ! Do not stress - do not take any tension ! This advise is even more pronounced during an IVF treatment cycle. If you want your IVF to succeed and the embryos to stick, you've got to "go with the flow" and not stress out. If you get too stressed out, your uterus will reject the embryos and they will not implant !This is very unhelpful advise ! Of course there's a lot of stress in an IVF cycle - after all, no one wants to come to Dr Malpani to have a baby ! All my IVF patients are stressed out - and even the hyper ones do get pregnant ! It's true that patients need to learn constructive w... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4501648 Mon, 21 Feb 2011 03:07:00 +0100 4501648 http://www.medworm.com/index.php?rid=4498303&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fwhy-dont-you-have-copy-of-your-ivf.html I see patients who have done IVF cycles in other clinics all the time. How they responded in the earlier IVF treatment cycle provides me with valuable information, based on which I can tailor a better treatment protocol for them.One of the basic questions I ask them is - Please tell me more details about your earlier IVF cycles . What were the meds which were used for superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? How many embryos were transferred ? What was the embryo quality ? DO YOU HAVE PHOTOS OF YOUR EMBRYOS ? What was the endometrial thickness ?Can you please show me the printed treatment summary from your IVF clinic ?Many of them look at me blankly. ( I am sure some of them ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4498303 Sun, 20 Feb 2011 03:01:00 +0100 4498303 http://www.medworm.com/index.php?rid=4495256&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fday-in-life-of-embryologist.html This is a guest post by Saiprasad Gundeti, Senior Embryologist, Malpani Infertility Clinic.As an embryologist, I help in making the dreams of infertile couples come true ! Most couples do not know what happens in an IVF lab, so I am happy to describe a day in my life !This is the daily routine we follow at our centre :First thing in the morning –Cleaning Cleanliness is a very important factor in IVF Lab. We need to make sure everything is sterile ! Because I work alone in our lab, it's much easier for me to ensure that everything is clean !Hood and bench work surfaces (including microscope working areas, heat baths, petridish warmer) are cleaned and wiped down with 6% Hydrogen Peroxide.Once a week centrifuge rotors and carriers as well as outside area of the centrifuge are cleaned and di... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4495256 Sat, 19 Feb 2011 04:43:00 +0100 4495256 http://www.medworm.com/index.php?rid=4495257&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fwhy-i-want-my-patients-to-become-ivf.html I want all my IVF patients to become an expert on IVF , which is why we spend a lot of time and energy in educating them; and in creating unique online educational tools to help them to learn more about IVF.Now, I am not trying to teach my patients how to do IVF in their bedroom ! The reason we want them to know as much about their treatment as possible is because this is the best way of explaining to them why we are so good at what we do - and what makes us better than other IVF clinics . The outcome of any IVF treatment is always uncertain, and no matter how good I am , there is no certainty that the IVF cycle will be successful. Also, it's a very competitive field, and there are over 40 IVF clinics in Bombay itself ! Sadly, most patients are quite clueless, and do not have the ability t... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4495257 Fri, 18 Feb 2011 13:26:00 +0100 4495257 http://www.medworm.com/index.php?rid=4482842&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fhappy-infertile-couple-from-spain-at.html In our quest of paternity, we made some treatments in our home country, Spain, but we got no success. After a period to find an alternative, we chose to go to Mumbai, India, and in fact Malpani Infertility Clinic. We had more contact with other clinics in India, through e-mail, forums, testimonials of patients who were with them, etc., but finally we opted for Malpani Infertility Clinic for many reasons that during the treatment were confirmed. In the talks held by e-mail us seemed honest, ethicals, professionals and they offered us a good humane treatment.Our experience began in summer 2010, and we decided to begin the pre-treatment that Dr. Malpani suggested us by e-mail while we were in Spain before treatment in Mumbai. He explained to me everything that had to do: medicine, testing, pl... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4482842 Wed, 16 Feb 2011 14:11:00 +0100 4482842 http://www.medworm.com/index.php?rid=4477836&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fone-womans-quest-for-egg-donor.html I was watching TV late one night , into the wee hours of the morning…I was so tired & bored that I started channel-surfing and I stopped on this program called “70&Pregnant” on the Discovery/TLC Cable Channel. Boy! Did it wake me up? Mark & I have tried for years to get pregnant and we realized about 15 years ago that because of my premature ovarian failure, only a donor egg would work for us. So needless to say when I saw this program, I perked up immediately…. On this program, they featured an Indian doctor who helped a 70 year old Indian lady get pregnant and have child with a donor egg. The donor came from a nearby Indian village & the cost was cheap by U.S.A. Standards for IVF.During the program, the doctor discussed the cost of IVF in Indian and immediately, s... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4477836 Mon, 14 Feb 2011 15:51:00 +0100 4477836 http://www.medworm.com/index.php?rid=4460017&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fwhy-are-men-so-reluctant-to-get-their.html Most men are very reluctant to get their sperm tested. For one, most men hate going to a doctor - and they need to be dragged to the clinic for any medical testing - whether it's a X-ray or a sperm test. Secondly, most men still believe that having a baby is their wife's job, so it's the wife who should get tested. For another, they expect that their sperm count must be fine , so why bother to get it tested ? " Hey - I can have sex as often as I want, and if my virility is fine, I am sure my fertility will be superb too ! Why waste time and money getting it tested ? " Finally, it can be quite humiliating to have to go to a lab to produce a semen sample - and this is an experience most men are quite happy to bypass.The problem is much worse for men who know that they have a low sperm count.... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4460017 Fri, 11 Feb 2011 02:34:00 +0100 4460017 http://www.medworm.com/index.php?rid=4459960&cid=t_105306_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcan-medical-clowning-improve-in-vitro-success%2F2011.02.10 Following from the somewhat common sense idea that women who were less stressed during in vitro fertilization and embryo transfer (IVF-ET) had better outcomes, the journal Fertility and Sterility published a study out of Israel that claims “medical clowning” improved pregnancy rates compared to a group not exposed to a clown on the day of implantation. From the abstract: This experimental prospective quasi-randomized study examining the impact of a medical clowning encounter after ET after IVF found that the pregnancy rate in the intervention group was 36.4%, compared with 20.2% in the control group (adjusted odds ratio, 2.67; 95% confidence interval, 1.36–5.24). Medical clowning as an adjunct to IVF-ET may have a beneficial effect on pregnancy rates and deserves further inve... Better Health blogs http://www.medworm.com/rss/comments.php?id=4459960 Thu, 10 Feb 2011 16:00:47 +0100 4459960 http://www.medworm.com/index.php?rid=4455317&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fsurrogacy-versus-embryo-adoption.html One of the major problems with surrogacy today is that it is overused and misused.This is especially true when surrogacy is advised for patients who have failed multiple IVF cyclesor had multiple miscarriages. These patients are very depressed and have very low self esteem. They often end up believing that it's their uterus which is defective; and they therefore believe that surrogacy would be their best treatment option. They often approach IVF clinics asking for surrogacy treatment - and many doctors are happy to oblige, because this is a very profitable treatment option !In reality, surrogacy is an expensive and complex treatment option, which is best reserved forwomen without a uterus. Research shows that the reason for failed implantation is much more likely to be genetically abnormal... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4455317 Thu, 10 Feb 2011 02:48:00 +0100 4455317 http://www.medworm.com/index.php?rid=4450344&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fi-have-failed-five-ivf-cycles-dr.html My patient was at her wit's end and was sobbing her heart out. I have done 5 IVF cycles all over the world, Dr Malpani - and they've all failed. What do I do next ?This is always a complex question - and there's no easy answer. You need to be analytical and logical, so we know what to do next. The trick is not to waste time looking for problems, but rather to focus on solutions which will allow us to bypass the problems !We need to ask ourselves - what have we learned from these failures ? What can we do differently the next time ? What can we change to increase the chances of success ?If you do need to change something, remember that there are only 5 things we can change in any IVF treatment1. The IVF treatment protocol2. The clinic3. The sperm4. The eggs5. The uterusLet's think through t... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4450344 Tue, 08 Feb 2011 04:12:00 +0100 4450344 http://www.medworm.com/index.php?rid=4436811&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fdr-malpani-tells-you-why-you-must.html The failure of an IVF cycle always causes major heartburn. The next question is - Why did the IVF cycle fail ? What should I do next ? Did I get good quality medical care ? Or should I change my doctor ?This is always a hard question to answer, because even if the quality of medical care provided is excellent, the IVF cycle can still fail. How is the patient to judge the quality of technical competence of the IVF clinic ? Did the cycle fail because the clinic was bad ? Or was it just bad luck ? You cannot rely on a doctor's bed side manner to judge his clinical skills - you need more tangible evidence - but what should you be looking for ?Fortunately, the answer is very easy - you should ask for photos of your embryos ! The core competence of a good IVF clinic is to produce high quality em... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4436811 Fri, 04 Feb 2011 13:22:00 +0100 4436811 http://www.medworm.com/index.php?rid=4429225&cid=t_105306_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F0bIqSuEDX98%2F It seems to remain true that some people just can’t count. Take the folks at West Coast IVF Clinic in Beverly Hills. A corporate entitly that is connected to the operation, which endeavors to help couples conquer infertility, received a warning letter from the FDA for violating rules pertaining to Institutional Review Boards. And these were rather basic rules. To wit, federal law requires that IRBs have at least five members and one must be primarily concerned with so-called non-scientific matters (in other words, someone with a different background and mission). Also, no IRB member is allowed to participate in reviewing any project in which this person may have a conflict of interest. But an FDA inspection of the Napoli LLC, which is housed in the same Wilshire Boulevard location as... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4429225 Wed, 02 Feb 2011 15:02:40 +0100 4429225 http://www.medworm.com/index.php?rid=4429072&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fdr-malpani-why-did-my-ivf-cycle-fail.html This is one of the commonest questions patients ask me. Doctor, I did an IVF cycle at this other clinic and it failed - can you please tell me why ?Obviously, the next thing I need to do is to drill deeper to find out more details about the medical treatment provided, so I can provide an intelligent answer.I ask patients for more details about their IVF cycle. What were the meds which were used forsuperovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? How many embryos were transferred ? What was the embryo quality ? What was the endometrial thickness ?Most patients look completely blank when I ask them these basic questions - and some even think I am crazy for expecting them to know the an... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4429072 Wed, 02 Feb 2011 04:14:00 +0100 4429072 http://www.medworm.com/index.php?rid=4419231&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fpart-time-versus-full-time-ivf-doctors.html Many gynecologists have started offering IVF services and at last count, there were over 45 IVF clinics in Mumbai ! The reason is because IVF is seen to be remunerative and profitable ! After all, why send the patient away to an IVF clinic and lose all that income ? Never mind that these gynecologists have never been trained in doing IVF or have never done a single IVF cycle in their life - after all, how hard can doing IVF be for a MD gynecologist ? Plus, there are now many companies which are happy to offer a 1-week workshop which certifies doctors as being IVF trained !This is why we are seeing a huge number of " part time IVF doctors" in India. They spend most of their time seeing OB patients and gynec patients - but rather than refer their infertile patients to IVF specialists, they h... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4419231 Mon, 31 Jan 2011 02:32:00 +0100 4419231 http://www.medworm.com/index.php?rid=4405844&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fsuccess-story-from-netherlands-baby.html This is a story about perseverance, courage but most of all a good understanding between a doctor and a patient.After some difficult years including infertility treatments, despair and discouragement by infertility doctors (!), my husband and I decided we should take a sabbatical and rest for a while from all the disappointments of the past. We decided to travel to Asia and visit some wonderful countries.After a few months however, my child wish was very strong again and we decided we should try one more time an IVF treatment.The question was where? we had all these possibilities in all of these countries.I decided to do a little research and I wrote to a dozen clinics in Thailand, Singapore, Malaysia and India.Some clinics did not respond at all (!) other were very short in their informat... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4405844 Thu, 27 Jan 2011 04:32:00 +0100 4405844 http://www.medworm.com/index.php?rid=4399631&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fwhat-expert-patient-can-teach-expert.html I am an IVF specialist, and know lots about IVF. I read all the medical journals and keep myself updated, so I can provide high quality medical care to my patients - after all, my professional knowledgebase is my major asset and I spend a lot of time on polishing my skills and keeping current with recent advances. Since IVF is such a specialised field, it's much easier for me to do so, as compared to a general physician, for example, who has a much broader area to cover.However, no matter how good my intentions, the fact still remains that there will be areas in IVF in which I have blind spots. The good news is that my patients are getting smarter and are happy to help me fill in these blind spots. I have always respected my patients and I learn a lot from them all the time.Medicine is a r... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4399631 Wed, 26 Jan 2011 04:24:00 +0100 4399631 http://www.medworm.com/index.php?rid=4382811&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fhow-i-improved-my-vitrification.html HOW I IMPROVED MY VITRIFICATION TECHNIQUE !SAIPRASAD GUNDETI, SENIOR EMBRYOLOGIST, MALPANI INFERTILITY CLINIC PVT. LTD.Vitrification involves freezing the embryo about 600 times faster than ever before. This ultrarapid process is so fast that it literally allows no time for intracellular ice to form. As a result, vitrification avoids trauma to the embryo.In conventional (slow) freezing, 20-30% of embryos do not survive the freeze-thaw, and those that do survive have less than half the likelihood of generating a pregnancy as do fresh embryos. In contrast, vitrified embryos have a better than 95% freeze-thaw survival rate, and a pregnancy generating potential that is comparable to fresh embryos.Vitrification is now regarded as potential alternative to conventional (slow)freezing.Major advant... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4382811 Fri, 21 Jan 2011 08:21:00 +0100 4382811 http://www.medworm.com/index.php?rid=4361084&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fpersistent-determined-infertile-nri.html Both my husband and I, born in India but raised almost entirely abroad (he in US, myself all over the world), met purely by chance in 2007 and got married soon after. I'm a career woman who got married very young and had put off having children when I became single again at 25. My husband had also married young and had 4 children, and found himself suddenly single again. After a whirlwind courtship and traditional Indian wedding, I was overwhelmed by gaining an instant family, but also felt a deep longing to experience motherhood for myself. However, I also had a complicated gynecological history and age was not on my side (I am 47), so did not share my husband's hopes that I would ever become a mother (other than through adoption). My husband and I tried one (very expensive) IVF cycle in ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4361084 Tue, 18 Jan 2011 05:59:00 +0100 4361084 http://www.medworm.com/index.php?rid=4349552&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fdoes-your-ivf-doctor-travel-lot.html Many IVF doctors in India travel extensively. They have many clinics all over the city ( and in some cases, all over the country). Naive patients get impressed by such doctors - wow - he is so busy and so much in demand that he needs to travel all over the place. In fact, some doctors even go to Dubai and Africa ! While this seems very impressive, in reality this means that the quality of care they provide to their patients leaves a lot to be desired. Let me explain.The personal goal for these doctors seems to be to maximise the number of patients they treat, so they can maximise their throughput and their revenue. While it's very good for an IVF clinic to be busy, it's also important that the quality of care provided to their patients not be compromised in the quest for quantity !How do t... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4349552 Fri, 14 Jan 2011 09:02:00 +0100 4349552 http://www.medworm.com/index.php?rid=4324823&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fpatients-with-poor-ovarian-reserve_08.html For many IVF clinics, the patients which cause the most distress are the ones who are poor ovarian responders. These are patients who have poor ovarian reserve - and are often heartsink patients, because no matter what we do , it's very difficult to get them pregnant !It is possible to get them to grow eggs and make embryos - and this actually makes the matter even more complex. This often creates false hopes - if I can make eggs and embryos, of course I can get pregnant ! All I need to do is to get the embryo to stick !Unfortunately, there is no easy answer, and every patient needs to look into their own heart to resolve this personal quandary for themselves. While we are very happy to aggressively superovulate these patients, I feel using expensive and unproven treatments ( suc... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4324823 Sat, 08 Jan 2011 04:37:00 +0100 4324823 http://www.medworm.com/index.php?rid=4314072&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fwhat-are-my-chances-of-getting-pregnant.html The commonest question patients will ask before starting an IVF cycle is - what are my chances of getting pregnant ?While it's true that the chances of success do depend upon how good your IVF clinic is, it's also true that the chances do depend upon biological factors which are outside your control - the most important one of which is your age !You can now use the Free IVF Predictor to estimate how good your chances of success are ! While you cannot do much about your age, you can improve your chances of success by choosing a world class IVF clinic ! (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4314072 Thu, 06 Jan 2011 05:12:00 +0100 4314072 http://www.medworm.com/index.php?rid=4314074&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Ftesting-for-pregnancy-after-embryo.html While all IVF patients understand with their heads that not every IVF cycle results in success, in their heart of hearts, every patient expects to get pregnant every time they do IVF ! This is why the 2ww after the embryo transfer can be so nerve-wracking ! Am I pregnant or not ? Have the embryos implanted or not ? The suspense during the 2ww can be even worse than the pain of the IVF injections !Most patients would love to have a test which will allow them to find out if they are pregnant immediately after the embryo transfer ! Have the embryos stuck or not ? Why can’t we do a pregnancy test and find out right now ? Even if I am not pregnant, at least it’s better to know than to be unsure.To understand why patients ( and their doctors ) still have to suffer through a 2 week wait to fi... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4314074 Thu, 06 Jan 2011 03:04:00 +0100 4314074 http://www.medworm.com/index.php?rid=4309820&cid=t_105306_136_f&fid=37846&url=http%3A%2F%2Fhealthinfoispower.wordpress.com%2F2011%2F01%2F04%2Flab-on-a-chip-veridex-mgh-collaborate-on-next-generation-circulating-tumor-cell-test%2F Veridex, LLC announces a collaboration with Massachusetts General Hospital to develop and commercialize a next-generation circulating tumor cell technology for capturing, counting and characterizing tumor cells found in patients’ blood. Yesterday, Veridex, LLC (Veridex) announced a collaboration with Massachusetts General Hospital (MGH) to develop and commercialize a next-generation circulating tumor cell (CTC) technology for capturing, counting and characterizing tumor [...] (Source: Libby's H*O*P*E*) Libby's H*O*P*E* blogs http://www.medworm.com/rss/comments.php?id=4309820 Tue, 04 Jan 2011 20:52:21 +0100 4309820 http://www.medworm.com/index.php?rid=4309687&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fwhy-do-i-have-to-wait-2-weeks-to-do.html Most patients find that one of the most difficult things to manage during an IVF cycle is the dreaded 2 week wait ( 2ww) after the embryo transfer. Time seems to come to a halt and you live in a state of suspended animation - a bit like Schroedinger's cat ! Am I pregnant ? Am I not pregnant ? Every ache and twinge sends you scurrying to the bathroom to check if your periods have started - and you over-interpret every signal your body sends you. Am I feeling nauseous ? Is this a good sign ? Do my breasts feel fuller than usual ? Is this just PMS ? You try to prevent your mind from playing games with you, but this is surprisingly hard to do. Every hour seems to stretch on like a day ! You obsessively compare notes with all your online IVF friends - and drive your husband batty with your inte... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4309687 Tue, 04 Jan 2011 03:28:00 +0100 4309687 http://www.medworm.com/index.php?rid=4304944&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fbehaviour-nurture-not-nature-says-ivf.html A long-term study following 1,000 families with children born using IVF between 1994 and 2002 in the UK and US has shown the importance of parenting in the outcome of a child's behaviour. In the study, which investigated the mental wellbeing of both the parents and children, some of the children were biologically related to their parents, while others were unrelated and conceived using either donor sperm or eggs, or both. This gave the researchers a unique opportunity to compare the role of nature (genes) and nurture (the environment) in the development of a child's behaviour.This is why patients who use donor gametes for IVF after counselling and forethought are usually very happy with their kids ! (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4304944 Mon, 03 Jan 2011 05:41:00 +0100 4304944 http://www.medworm.com/index.php?rid=4294742&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F12%2Ftop-ten-tips-for-facing-infertility.html One of the most amusing books I have read on infertility is: A Few Good Eggs : Two Chicks Dish on Overcoming the Insanity of Infertility by Julie Vargo and Maureen Regan. The book is targetted towards infertile women living in the US, and is written in the currently fashionable "chick-lit" style. It's amusingly written; and is a breath of fresh air , if you are the sort of person who finds a sense of humour helps you cope better with infertility. The book has lots of Top-10 lists, and here's their list of Top Ten Tips for Facing Infertility. # 10 Tips for Facing Infertility1. Keep reminding yourself that you are not alone.2. Realize that dealing with infertility is an all-consuming process.3. Stay calm.4. Remind yourself you are not a failure if a procedure doesn't work.5. Have a sense of ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4294742 Wed, 29 Dec 2010 05:02:00 +0100 4294742 http://www.medworm.com/index.php?rid=4288581&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F12%2Fhow-can-you-be-sure-your-ivf-clinic-is.html One of the major decisions infertile patients have to make is - How to pick a really good IVF clinic? The majority of IVF treatment centers appear to be identical on paper, and their websites are quite similar (because some unethical doctors will unashamedly copy and paste content from our website!). Many have happy patients - and most IVF specialists talk the identical talk - all of them quote high success rates and claim they are the finest! Exactly how is a poor patient supposed to separate the wheat from the chaff and assure himself that the IVF clinic he's going to is efficient? After all, while it is easy for patients to evaluate a doctor's bedside manner, it's difficult for them to make a call concerning his medical and technical proficiency.Simply because the IVF cycle fails doesn'... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4288581 Sat, 25 Dec 2010 04:31:00 +0100 4288581 http://www.medworm.com/index.php?rid=4281363&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F12%2Fquality-of-doctors-answers-depend-upon.html Recently I witnessed an infertile couple who had over three heavy files bulging along with medical tests and reviews. They may have visited more than ten infertility experts who tried every single possible examination under the sun to attempt to discover what their issue was. The lady had been examined for antisperm antibodies, NK cells , hostile cervical mucus, tuberculosis, chlamydia, sperm DNA fragmentation… you name it, and she had had the examination done. Every single gynaecologist had repeated test after test, however every result had been normal. They were at their wit’s end. “Why can’t I get pregnant , doctor , if things are all normal ?” was her plaintive cry.I was surprised about how little she had learned after going to numerous doctors. Rather than understanding from... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4281363 Thu, 23 Dec 2010 04:57:00 +0100 4281363 http://www.medworm.com/index.php?rid=4251159&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F12%2Fhappy-nri-patient-from-usa.html We live in the US and I was diagnosed with Polycystic Ovarian Syndrome in 2003. We had been to an obgyn in the US and she had recommended 3 cycles of clomid treatment. Since this did not work for us, she had asked us to go for higher infertility treatments like Artificial Insemination or IVF. At that point we did not have proper information regarding these treatments and hence were not mentally prepared to proceed further.Later we started research on the Internet regarding various infertility treatment options for us. It was at this time that we came across this amazing website. Dr.Malpani's website is an excellent source of information for infertility related issues. This was a panacea for all our questions. We then started interacting with Dr.Malpani through his website. We submitted the... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4251159 Sat, 11 Dec 2010 15:15:00 +0100 4251159 http://www.medworm.com/index.php?rid=4207352&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F11%2Fcanadian-couple-success-story.html We have been married for 7 years now. We tried to get pregnant after the first year of marriage with no success. We then tried IVF clinics in Canada the first Doctor we went to we did IVF it was a positive result only to find out that it was a chemical pregnancy. We took that very hard because we wanted to have a baby and we wanted to start our family right away. This Doctor told us that because of age that we had to use a donor’s egg we despised that thought we did not accept it so we decided to go to another Doctor. We were with this Doctor for 2 years trying all kinds of treatment, firstly , IUIs with no success, we then decided to try IVF again but every cycle my eggs got lesser and lesser and not developing the way they should for a successful IVF procedure so I we would be detour t... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4207352 Sun, 28 Nov 2010 17:18:00 +0100 4207352 http://www.medworm.com/index.php?rid=4151921&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F11%2Fhow-can-i-be-sure-my-ivf-doctor-is.html One of the major worries most IVF patients have is about the competence of their IVF doctor. While most patients select an IVF clinic based on its reputation, the sad truth is that there is not much correlation with the actual quality of the medical treatment they receive and the brand name of the clinic. Many "big name" clinics are very impersonal and are run like assembly lines. The patient rarely gets to meet the doctor and most of the care is provided either by the nurses of the assistants. Patients feel they are helpless and passively put up with poor quality care, because they do not know what else they can do.A much bigger problem is the lack of transparency and documentation . Most IVF clinics do not even bother to provide patients with a simple treatment summary ! Patients are clu... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4151921 Wed, 10 Nov 2010 05:46:00 +0100 4151921 http://www.medworm.com/index.php?rid=4139308&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fwhy-are-patients-so-naive.html I just saw a patient who was at her wit's end. She had done 4 IVF cycles at the same clinic and had failed all of them. She was angry; and was complaining bitterly about how badly the doctor at the IVF clinic had treated her. " She would make us wait for hours - and we only got a chance to talk to her at the first consultation. After this, all the care was provided by her assistants, who refused to allow us to meet Madam ! "I asked her some basic questions about her medical treatment. " I need more details about your prior IVF cycles . What were the medications which were used for superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? How many embryos were transferred ? What was the embryo... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4139308 Sat, 06 Nov 2010 07:52:00 +0100 4139308 http://www.medworm.com/index.php?rid=4119138&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fhow-do-we-decide-how-many-embryos-to.html Saiprasad Gundeti, Senior Embryologist, Malpani Infertility ClinicThere are multiple variables which need to be considered while deciding how many embryos to transfer.When we decide about the number of embryos to transfer , our aim is to :Select Top Quality Embryo(s) for transferMaximise the chances of pregnancy.Minimise the risk of failure.Minimise the risk of multiple pregnancy.Each country has its own policies depending upon their patient population, their healthcare system and their laws.In Scandinavian countries , not more than one embryo is allowed to be transferred.In such countries, doing a Day 5 transfer is ideal.Top Quality Day 5 EmbryoThat’s not the case in India where we can transfer multiple embryos. However, we need to individualise this decision for each patient ! More is ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4119138 Thu, 28 Oct 2010 05:32:00 +0100 4119138 http://www.medworm.com/index.php?rid=4105787&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Funexplained-infertility-vs-incompletely.html Many patients are diagnosed with having unexplained infertility. This means that all their fertility tests - semen analysis; hormonal blood tests ( FSH,LH,PRL,TSH and AMH) for egg quality; HSG ( hysterosalpingogram) for tubal patency; and ultrasound scanning for ovulation monitoring are normal.This can be a very frustrating diagnosis for patients. " But doctor, if everything is normal, then why aren't I getting pregnant ? " Patients are never happy with doctors who honestly answer - We do not know ! Patients expect a scientific definitive answer from their doctor who is meant to be an expert - and if a doctor cannot provide this, then be mustn't be very competent at his job is the natural conclusion many of them jump to . The truth is that our technology for identifying problems is still v... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4105787 Mon, 25 Oct 2010 02:19:00 +0100 4105787 http://www.medworm.com/index.php?rid=4098097&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fmaking-sense-of-your-infertility.html I just saw an infertile 42 year old woman who said - Doctor, my husband has a low sperm count. Can you please prescribe some medicines so we can improve it and have a baby. "It always amazes me that even in this day and age so many infertile couples do so little to try to make sense of their treatment options.Many find it very hard to decipher the medical terms their doctor uses. They do all the tests the doctor asks for - and are often completely lost when he then explains to them what the next action steps are.Unfortunately, many doctors also "complexify" matters rather than simplifying them. They take a perverse pride in doing so, because it allows them to position themselves as experts in a difficult subject which the poor patient will never be able to understand !I think they just mak... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4098097 Sat, 23 Oct 2010 01:42:00 +0100 4098097 http://www.medworm.com/index.php?rid=4082151&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fwhy-do-doctors-advise-bed-rest-after.html When an infertile patient gets pregnant after IVF , they are on top of the world. All that hard work and effort has finally paid off - and you can now look forward to cradling your baby in your arms soon !However, there are still 8 months to go before your baby is born - and the pregnancy can be packed with anxiety and suspense. Will everything go well ? Will the baby be normal ? Every ache and twinge causes worry because you are scared you may miscarry. This is a "precious pregnancy" - and you do your best to take things easy and be as careful as you can, so you can nurture your baby.This is one of the reasons why many doctors advise bed rest during an IVF pregnancy. In fact, some patients will voluntarily place themselves under house arrest, because they do not want to take the slightest... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4082151 Tue, 19 Oct 2010 03:02:00 +0100 4082151 http://www.medworm.com/index.php?rid=4077351&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fabuse-and-misuse-of-surrogacy.html Surrogacy in India gets a lot of press - and often for all the wrong reasons.There's a lot of talk about how rich Westerners are coming to India for surrogacy and exploiting poor women by using their uterus to have a baby.Actually, it is true that there is a lot of exploitation occurring - but it's not just the poor women who are being exploited.In my opinion, a lot of the exploitation is by the IVF clinics - but not of the poor women, but of the rich infertile couples who come to them for treatment !Many infertile couples are quite desperate to have a baby and are willing to clutch at straws. They've read a lot about how India has become the surrogacy capital of the world - and how it is much less expensive to do surrogacy in India than in other parts of the world. Because so many of them... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4077351 Mon, 18 Oct 2010 12:40:00 +0100 4077351 http://www.medworm.com/index.php?rid=4077354&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Ftaking-infertile-patients-for-ride.html I got an email from a patient whose fallopian tubes were blocked at the fimbrial end. I explained to her that her best option would be IVF.She was very concerned about how expensive IVF was; and wanted to explore alternative options. She sent me a link to this website - Blocked Fallopian Tube Kit (USA & Canada)http://biotanicalhealth.com/products/blocked-fallopian-tube-kit-usa-canada and asked me my opinion as to whether this would be useful.Visiting this site made my blood boil - and also taught me a lot about how people will prey on an infertile patient's desperation and ignorance and take them for a ride. It's also a great example of clever marketing ! The manufacturer has cleverly packaged a few herbs, tampons, books and DVDs ( costing about US $ 50) - and is selling them as a Kit ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4077354 Sun, 17 Oct 2010 07:23:00 +0100 4077354 http://www.medworm.com/index.php?rid=4074174&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fwhy-i-prefer-email-as-compared-to-phone.html We treat patients from all over the world and many of them want to do a phone consultation with me before coming to our clinic for an IVF treatment.I can understand why they want to do so - after all, going half way across the world to get treated by a doctor you've never seen or met is a major leap of faith - and talking to the doctor can help to reduce some of this anxiety !While it's true that the human touch is very important in providing good medical care, the truth is that it's not humanly possible for me to do so. This is true for many reasons.For one, because of time zone differences, it's quite difficult to find a time slot which suits both the patient and me. We often end up playing phone tag - causing even more frustration ! Also, phone connections in certain countries ( such as... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4074174 Fri, 15 Oct 2010 02:22:00 +0100 4074174 http://www.medworm.com/index.php?rid=4065427&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fare-ivf-injections-painful.html One of the major reasons patients do not want to do IVF is their fear of injections. They know that during IVF they need to take injections for many days - and many patients are understandably reluctant to take these shots because they have been told that these injections are painful !While it's no fun to take injections , the good news is that the injections used for IVF treatment are not painful !Lupron and Anatgon ( which are used for downregulation) and given subcutaneously, just like a diabetic takes insulin injections. these are easy to self-administer and are not painful.The injections which are used for superovulation ( the urinary gonadotropins such as Menogon) used to be given intramuscularly. IM injections are more painful than subcutaneous injections, because a larger volume ne... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4065427 Thu, 14 Oct 2010 02:44:00 +0100 4065427 http://www.medworm.com/index.php?rid=4060910&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Ffailed-fertilisation-after-ivf.html Most IVF clinics are very good at making embryos in vitro, which means that for most patients, each IVF cycle results in the formation of embryos which they can admire.( Tip: If you are doing IVF treatment, insist that the clinic give you photos of your embryos. This is the best documentation that you have received good quality medical care. You have a legal right to your medical records - every hospital has to provide them by law ! Please make a request for this in writing ! Poor quality documentation without photos of your embryos suggests you have received poor quality medical care !)However, sometimes there is complete failure of fertilisation, as a result of which no embryos are formed. This can be a rude shock to the patient, and causes major heartburn !Why do the sperm fail to ferti... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4060910 Tue, 12 Oct 2010 03:54:00 +0100 4060910 http://www.medworm.com/index.php?rid=4053364&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Ffear-of-ivf.html Many infertile couples are afraid of doing IVF. For some of them, the fear is so overwhelming, that they refuse to even consider this option, thus depriving themselves of their best chance of having a baby !There are many reasons for this fear - it can be a long list !fear of injectionsfear of painfear of side effectsfear of multiple pregnanciesfear of anesthesia ( once I sleep, will I wake up again ?)fear of failurefear of expenseI think it's important for patients to face up to their fears - and the best way of doing this is to reframe your perspective ! Many of these fears are untrue and irrational.Its true that IVF is expensive; and that the outcome is always uncertain; but the only risk is emotional and financial. There is no medical risk and no pain ; and it's important to explode th... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4053364 Sat, 09 Oct 2010 05:37:00 +0100 4053364 http://www.medworm.com/index.php?rid=4040626&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fmanaging-your-anxiety-before-ivf.html While most patients can handle the medical bits and bobs of an IVF treatment cycle quite easily, dealing with the anxiety which an IVF cycle involves can be very challenging.I just saw a 38 year old patient who had a low AMH level. She had been advised IVF, and wanted a second opinion as to whether this was a good option for her.Given her advanced age and her low AMH level, I told her that she had reached the oopause. I agreed that she needed IVF, because time was at a premium for her.When I said this, she because very agitated. I did my best to try to calm her down, but she seemed to get even more anxious." What are you worried about ? Pain ? side effects ? the expense ? "" No, doctor, I am worried that I am now too old. I know that my low AMH level means my eggs are poor quality, and tha... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4040626 Thu, 07 Oct 2010 02:01:00 +0100 4040626 http://www.medworm.com/index.php?rid=4036744&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fpoor-quality-ivf-medical-treatment.html It breaks my heart when I see how poorly patients are informed about their IVF treatment. It seems to be a conspiracy of silence - and most doctors seem to be extremely stingy about sharing medical details with their patients . I find this very difficult to understand - after all, the patient has a legal right to their medical records.Many IVF clinics provided printed treatment summaries - which conceal more than they reveal.I have attached an image of a " treatment summary" of a patient who had IVF done in a leading IVF clinic in Delhi ( name removed to protect the guilty !).While it seems quite impressive , there is no medical information in it at all ! The doctor does not even specify how many eggs were collected !There are no details about the embryo quality - or even how many embryos ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4036744 Wed, 06 Oct 2010 02:47:00 +0100 4036744 http://www.medworm.com/index.php?rid=4031324&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fbut-i-am-not-doctor-doctor.html I will often ask my patients for their inputs during their IVF treatment cycle. I feel patients should be well-informed and I see my role as a technical facilitator . My goal is to empower my patients so that they can make the right decisions for themselves and not have to depend upon me.When I ask my patients to decide, many of them look at me as as I was crazy. Most Indian patients are used to dealing with doctors who have a much more paternalistic style, and most are used to being told what to do by their doctor.A common response to my question , What would you like to do ? is - But I am not a doctor ! This has 2 sub-texts - You are the doctor, which means you are the expert, so you should decide. Secondly, because I am not a doctor, I do not understand much about IVF, so do not feel I ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4031324 Tue, 05 Oct 2010 15:46:00 +0100 4031324 http://www.medworm.com/index.php?rid=3976546&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F09%2Ftreatment-independent-pregnancies.html Many IVF specialists have seen couples who do not get pregnant in the IVF cycle and then promptly conceive in the next month ! Even couples whom we think have no business getting pregnant do so all the time ( for example, those with very low sperm counts or poor ovarian reserve ) !This is why IVF specialists no longer use the word sterility. We prefer the description, infertility, because this emphasises the fact that fertility is a relative term !So are all these pregnancies miracles ? Not really ! When some patients fail an IVF cycle, they just give up. They believe - " If the IVF cycle failed, this means I am never going to get pregnant on my own , so why bother ? "Others take a completely different approach. " If Dr Malpani can make embryos for me in his lab, I can do so for myself in ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3976546 Fri, 17 Sep 2010 03:23:00 +0100 3976546 http://www.medworm.com/index.php?rid=3973009&cid=t_105306_122_f&fid=35068&url=http%3A%2F%2Fbrainwindows.wordpress.com%2F2010%2F09%2F15%2Fupdate-diadem-final-results%2F The DIADEM automated neuronal reconstruction contest has finished.  Accurate, fast, and high-resolution automated neuron reconstruction is of vital importance to cracking the mystery of how neural circuits perform. Even with perfect knowledge of the firing patterns of every cell in a circuit, our understanding of how these patterns are produced and how the information is processed would be quite limited.  True understanding requires knowledge of the precise wiring diagram.  This prize is a good first step towards bringing awareness of this tricky problem to the world’s best computer scientists. $75,000 in prize money was to go to the group that was able to produce high-quality reconstructions of neuronal structures at least 20x faster than by-hand reconstructions.  In the finals... Brain Windows blogs http://www.medworm.com/rss/comments.php?id=3973009 Wed, 15 Sep 2010 19:23:46 +0100 3973009 http://www.medworm.com/index.php?rid=3929296&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F09%2Fwhat-precautions-should-i-take-after.html One of the commonest questions patients ask me is - " Doctor, what are the dos and don'ts after the embryo transfer ? " They are very worried about the risk of failure, and are petrified that they may end up doing something which will cause their embryos to "fall out" of the uterus. Many will often spend the entire 2 week wait obsessing about their diet and physical activity.Some will even put themselves on voluntary house arrest. Even worse, their relatives will often force them to sleep in bed for 14 days after the transfer. And to add insult to injury, many IVF doctors will also "advise" this !Why do we still continue to perpetuate this myth ? I think it's partly doctors who are responsible For one thing, many doctors do not bother to educate their patients that physical activity will n... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3929296 Fri, 03 Sep 2010 04:32:00 +0100 3929296 http://www.medworm.com/index.php?rid=3924963&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F09%2Fhow-some-ivf-clinics-lie-to-their.html Many IVF clinics are desperate to get patients. This is especially true for new clinics which have just been started in small towns and cities. Though they have not been able to achieve a single pregnancy, they do their best to attract patients, and often lie in order to do so.Unfortunately, many patients are not sophisticated enough to be able to separate fact from fiction, and will often get taken for a ride.1. " Our pregnancy rates are 45%". This is the commonest lie. Most clinics do not bother to keep data or report their personal pregnancy rates. Most will just "borrow" the highest success rates of the best IVF clinics, and claim to have the same results. This is a lie - but there's no way the patient can find out the truth !2. " Our doctors come from Bombay. " Some IVF clinics pride ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3924963 Thu, 02 Sep 2010 04:01:00 +0100 3924963 http://www.medworm.com/index.php?rid=3920925&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F08%2Fmaking-use-of-tradtional-remedies-for.html Infertile couples in India will often resort to using traditional medicines . Many will go to temples and take a prasad or tie a holy thread to help them to have a baby. Not only does traditional medicine have a long history in India, it has also helped many couples with unexplained infertility to have a baby, which means it has an established track record of success !However, many modern IVF doctors make fun of these "remedies". They believe these are useless, and will often discourage a patient from adopting these.It's not smart to do this. A good doctor respects a patient's beliefs, and understands that different people have different world views - and there is no one right way of looking at things ! After all, IVF specialists and Western medicine do not have a monopoly on the truth !Th... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3920925 Tue, 31 Aug 2010 05:55:00 +0100 3920925 http://www.medworm.com/index.php?rid=3907663&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F08%2Fluf-syndrome-and-infertility.html In normal healthy fertile females, ovulation with rupture of the mature ovarian follicle and release of the eggs occurs within 38 hours of the surge in luteinizing hormone (LH). However, in a small percentage of women, the dominant follicle will undergo the luteinization process but will not rupture following the midcycle LH surge. This is called LUF (luteinized unruptured follicle syndrome). As a result of the increased progesterone secretion, the endometrium undergoes the secretory changes, but, obviously, without the release of the oocyte , pregnancy cannot occur. This means that the cycles are regular; and hormonal studies ( Day 21 progesterone level) , the basal body temperature curve, and the findings in an endometrial biopsy will all be consistent with ovulation.This is obviously a ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3907663 Fri, 27 Aug 2010 00:45:00 +0100 3907663 http://www.medworm.com/index.php?rid=3889174&cid=t_105306_122_f&fid=35068&url=http%3A%2F%2Fbrainwindows.wordpress.com%2F2010%2F08%2F20%2Fsoftware-update-ephus-scanimage-neuroptikon%2F Three excellent pieces of neuroscience software have been recently updated or freshly released.  I have used two of them, Ephus and ScanImage, on a daily basis as primary data collection tools. The third, Neuroptikon, is quite useful for post-hoc illustration of neural circuits. Ephus is a modular Matlab-based electrophysiology program that can control and record many channels of tools and data simultaneously.  Under control of a sophisticated internal looper or external trigger, you can initiate an ephys recording, trigger camera frames, adjust galvo positions, open/close shutters, trigger optical stimulation, punishments, rewards, etc.  It is a workhorse program for non-imaging related in vitro and in vivo electrophysiology experiments.  Ephus is named for the fabled baseball pitch,... Brain Windows blogs http://www.medworm.com/rss/comments.php?id=3889174 Fri, 20 Aug 2010 23:51:53 +0100 3889174 http://www.medworm.com/index.php?rid=3865325&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F08%2Fexpert-patient.html When patients have a medical problem, they come to doctors asking for help . They expect the doctor to provide solutions ; and the traditional model is that the doctor reviews the problems and offers the right treatment. The patient complies with this and gets better, so that everyone is happy.In real life, things are far more complex.What happens when the doctor and patient do not see eye to eye ? What if the patient is not happy with the solution which the doctor offers ? Usually, patients are scared of doctors and are reluctant to express their disagreement openly. Most will nod their heads, pretend to agree - and then walk out and find another doctor ( if they can afford to do so) who provides an alternative solution they are happier with. However, this is not a happy solution, either ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3865325 Fri, 13 Aug 2010 13:35:00 +0100 3865325 http://www.medworm.com/index.php?rid=3862075&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F08%2Fwhy-are-young-fertile-women-doing-ivf.html I saw a 28 year old business executive today , who had an unusual request. " Doctor, I want you to do IVF for me ! I know I am most probably fertile, but my husband and I are both very busy and are finding it hard to find the time to make a baby, because we both travel so much. I want to have a baby quickly and do not want to waste time. IVF is more efficient than natural sex , so I want to do this in this month. Can you do this for me ? I know that natural Human reproduction is a very inefficient enterprise - and the chances of a pregnancy in one month are about 25%. I checked my husband's diary and mine and compared it with the free online fertility calculator . It seems that the only time we will be together during my fertile time is in Nov 2010 and Feb 2011. I don't want to waste time ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3862075 Thu, 12 Aug 2010 10:41:00 +0100 3862075 http://www.medworm.com/index.php?rid=3854588&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F08%2Frisks-and-complications-of-ivf.html Open publication - Free publishing - More infertility (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3854588 Tue, 10 Aug 2010 17:34:00 +0100 3854588 http://www.medworm.com/index.php?rid=3848953&cid=t_105306_122_f&fid=35068&url=http%3A%2F%2Fbrainwindows.wordpress.com%2F2010%2F08%2F09%2Fcameleon-nanos-high-affinity-gecis%2F Takeharu Nagai’s lab has published in Nature Methods, Spontaneous network activity visualized by ultrasensitive Ca2+ indicators, yellow Cameleon-Nano, demonstrating a new set of calcium indicators based on yellow cameleon. Back when he was still Take-san, Take’s ability to churn out and manually screen hundreds of cameleon variants was impressive and inspiring. With high-throughput GECI pipelines now ramping up at Janelia, the idea of laboriously screening 200 variations on a theme (be it cameleons or GluSnFRs), seems a bit archaic. However, this paper is a good example of the progress that can still be made by understanding the needed sensor parameters and fiddling with the primary amino acid structure in a relatively low-throughput way. Take-sensei’s results are another... Brain Windows blogs http://www.medworm.com/rss/comments.php?id=3848953 Tue, 10 Aug 2010 03:52:04 +0100 3848953 http://www.medworm.com/index.php?rid=3822989&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F08%2Fftr-fallopian-tubal-recanalisation.html In some infertile women, the fallopian tubes are blocked at the uterine ( cornual) end. Recanalization is a minimally invasive procedure used to open the blocked fallopian tubes in these patients. The diagnosis of cornual block or proximal tubal occlusion ( PTO) is made usually by doing a X-ray of the uterus and tubes, called a hysterosalpingogram ( HSG) or a laparoscopy. Fallopian tube recanalization is a relatively new reproductive technique , in which an X-ray of the uterus is performed, using a dye to visualise the uterine cavity and the site of the block, with the help of an advanced X-ray machine called an image intensifier. In patients who demonstrate a tubal block on X-ray, a guide wire or a balloon is passed to the area of tubal blockage & the block is opened up. In women who... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3822989 Wed, 04 Aug 2010 11:30:00 +0100 3822989 http://www.medworm.com/index.php?rid=3816481&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F08%2Fwhy-is-care-provided-in-most-ivf.html Most patients will vouch for the fact that the care provided in many IVF clinics leaves a lot to be desired. The clinic does not seem to have a treatment plan or protocol - and even if it does, this is not shared with the patient, who is often clueless about what is going to happen next ! There is very little communication amongst the staff, and often it seems that the right hand does not know what the left hand is doing. It seems that all the treatment is done on a daily, ad-hoc basis, and this lack of transparency create a lot of unease and distress. Also, because the senior" doctor is never available , it seems that all the decisions are made by assistants or nurses !There is often poor communication between the clinic's staff members , who may end up providing contradictory information... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3816481 Tue, 03 Aug 2010 10:46:00 +0100 3816481 http://www.medworm.com/index.php?rid=3798631&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fall-about-ivf-graphic-guide-part-4.html Open publication - Free publishing - More infertility (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3798631 Thu, 29 Jul 2010 05:15:00 +0100 3798631 http://www.medworm.com/index.php?rid=3790771&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fworlds-first-ivf-and-infertility-sms.html Malpani Infertility Clinic, in partnership with MyToday, is pleased to announce that we have now started publishing the world's first patient education channels on IVF and infertility.The mobile is a great tool for educating patients - and using SMS we hope to be able to remove a lot of the myths and misconceptions which surround this emotionally sensitive topic !You can see all our SMS Infertility Channels here.You can also subscribe free to our IVF channel here !At present, this service is available in India only. (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3790771 Tue, 27 Jul 2010 07:41:00 +0100 3790771 http://www.medworm.com/index.php?rid=3786179&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fblocked-fallopian-tubes-and-infertility.html Blocked fallopian tubes are one of the commonest causes of infertility. The fallopian tubes project out from each side of the body of the uterus and form the passages through which the egg is conducted from the ovary into the uterus. The fallopian tubes are about 10 cms long and the outer end of each tube is funnel shaped, ending in long fringes called fimbriae. The fimbriae catch the mature egg and channel it down into the fallopian tube when released by the ovary . The tube itself is a muscular highly movable structure capable of highly coordinated movement. The egg and sperm meet in the outer half of the fallopian tube, called the ampulla. Fertilization occurs here, after which the embryo continues down the tube toward the uterus. The uterine end of the tube, called the isthmus, acts li... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3786179 Sat, 24 Jul 2010 13:28:00 +0100 3786179 http://www.medworm.com/index.php?rid=3757946&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fhow-old-is-too-old-to-have-baby.html Right now the world record for the oldest mother has been set in India and the oldest woman who has given birth is 73 ! At an age when most women have become great-grandmothers, is it sensible for a woman to want to have a child ?Let’s explore this in more detail. Let’s suppose we decide , like some countries have done, that the age cut-off should be 45 and that women who are more than 45 should not be allowed to have IVF treatment, because they are “too old”. Then what happens if a 46 year old woman who is otherwise very healthy wants to have a baby ? Is it fair to say no to her just because she is one year past the cut off age ? Why ?It’s quite likely that older woman are going to make very good mothers. They are mature – and have spent a lot of time and energy in making this... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3757946 Fri, 16 Jul 2010 08:03:00 +0100 3757946 http://www.medworm.com/index.php?rid=3746829&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fhow-to-fool-ivf-patients.html Infertile patients are very vulnerable, and it's quite easy to fool them. Sadly, many IVF clinics will do so ruthlessly.Here are some of the ways IVF clinics provide a sub-standard service to their patients.1. They do not have the required training or expertise. It's shocking, but one of India's "leading" IVF clinics is run by a doctor who is a skin specialist ! ( Check out the resume and biodata of the doctor carefully - and ask to see his medical degree, if you do not want to be taken for a ride !)2. They do not have the required staff members . Many IVF clinics do not have a full-time embryologist, which means the IVF lab is often poorly run and the equipment not quality controlled or tested on a regular basis.3. They quote success rates which are inaccurate and inflated.4. They do not ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3746829 Tue, 13 Jul 2010 06:05:00 +0100 3746829 http://www.medworm.com/index.php?rid=3743578&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fwhat-tests-should-i-do-after-failed-ivf.html There's lots of pressure on IVF doctors when an IVF cycle fails. Patients want a baby - and since they have not succeeded, they want answers as to why the cycle failed !Doctors will take one of 3 approaches.Many are nihilistic. They know that the tests we have today do not help much. Our technology is still fairly crude, because the commonest cause of failed implantation is genetically abnormal embryos, and we still cannot detect or prevent these, given the fact that human reproduction is a very inefficient enterprise. The best option for most patients is to just try again, and this is what they will advise.Unfortunately, this straight-forward forthright approach is very difficult for most patients to accept . They want answers to their questions !Unfortunately, the truth is that our techn... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3743578 Sun, 11 Jul 2010 18:08:00 +0100 3743578 http://www.medworm.com/index.php?rid=3742311&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fafter-failed-ivf-cycle-whats-next.html I just got this email from a patient.Doctor, I am now at my wit's end ! I have failed 4 IVF cycles at 2 different clinics. The doctor transferred 2 beautiful blastocysts each time ! What do I do next ? My doctor is advising surrogacy, since he believes my uterus is rejecting the embryos.IVF failure is reproductive medicine's most frustrating problem ! When beautiful embryos fail to implant in a perfect cycle , it's often impossible to determine "what went wrong" ! A knee jerk reflex is to then consider surrogacy.However, surrogacy is an expensive and complex treatment option, which is best reserved forwomen without a uterus. Research shows that the reason for failed implantation is much more likely to be genetically abnormal embryos , rather than a uterine problem.Just because the embryo t... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3742311 Sat, 10 Jul 2010 13:31:00 +0100 3742311 http://www.medworm.com/index.php?rid=3740683&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fplace-to-bond-for-infertile-couples.html Mumbai: Infertility, to those faced by it, can be as emotionallydebilitating as the loss of a loved one. Most people find it extremely hard to accept that they are infertile andthe stress of denial can even lead to serious psychological problems. After dealing with scores of couples who approached them with such issues, Dr Aniruddha Malpani and wife Anjali formed a support group called Infertility Friends where men and women who have overcome their circumstances help counsel those still coming to terms with it. The group has been around for 15 years and is still going strong. Infertility Friends is the first such support group in the country for infertility. It is a registered charitable trust run by infertile couples and provides a forum for infertile couples where they can get together... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3740683 Fri, 09 Jul 2010 13:27:00 +0100 3740683 http://www.medworm.com/index.php?rid=3737105&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fovercoming-fear-of-ivf-failure.html The fear of failure is perhaps the commonest reason why most women do not have the courage to try a second IVF treatment cycle when the first one fails.But playing it safe has risk as well. If you never dare to fail , you will never succeed !Here's a great post on how to overcome the fear of failure ! (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3737105 Fri, 09 Jul 2010 05:01:00 +0100 3737105 http://www.medworm.com/index.php?rid=3718475&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fdid-doctor-cheat-us.html I got this email from a patient today.I am 28 years old . I require your help. Recently I had a IVF done through the doctor based in Mumbai. The doctor had extracted around 10 ovums and informed that they were of very good quality.Ovum pickup was on 1st June and he got 6 healthy embryos and he transferred 3 healthy embryos on 3rd june and advised complete bed rest with progesterone tablets to be inserted in the vagina and other injections and tablets etc. He was saying many times that everything is fine and confirmed 110% pregnancy as everything was fine. My uterus was strong etc. etc. I had blood test done on 19th June and it confirmed pregnancy. I was very happy. Later again on 24th when the blood test was done he said the foetus did not grew properly and got aborted. I started bleeding ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3718475 Fri, 02 Jul 2010 05:11:00 +0100 3718475 http://www.medworm.com/index.php?rid=3718476&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F07%2Fdoctor-what-makes-you-better-than-other.html Image via Wikipedia" Doctor, what makes you better than the other IVF doctors ?" Lots of patients ask us this question. The assertive ones do so point-blank, while most are much more tactful !This is a reasonable question, since selecting the right IVF clinic is a major decision, which involves a lot of soul-searching and thought.Saying " Because we are the best" really doesn't help - I am sure all doctors think they are the best !So what makes us better ?It's true that the basic principles of IVF treatment remain the same in all clinics. Patients are the same all over the world, as are doctors - and we all read the same medical textbooks and medical journals; and use the same drugs and medical equipment !So what makes some doctors better than others ?All cricketers use the same bat to hit... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3718476 Thu, 01 Jul 2010 15:48:00 +0100 3718476 http://www.medworm.com/index.php?rid=3714273&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fhow-bad-ivf-clinics-reduce-their.html I just got this email from a patient.I am a patient with azoospermia. My wife's reports are perfect with no fertility problems.We are undergoing TESE- ICSI in a fertility clinic in Bangalore. My wife was superovulated with RECAGAN 100IU which she has been taking for the last 10days . Today's scan result shows 14 mature follicles . The sizes are:Right ovary 2.1*1.7 1.8*1.4 1.7*1.3 1.9*1.2 1.6*1.5 1.6*1.4 1.6*1.4 Left ovary 1.8*2.2 1.9*1.6 1.6*1.5 1.8*1.4 1.4*1.3 1.7*1.2 1.5*0.9According to the original plan , we were supposes to take HCG tonight (11th day of the period) and the egg retrival was planned for Wednesday . However, due to non-availability of " TESA Specialist " they are postponing the egg retrival by 3 days and HCG injection by 2 days. We have been asked to continue injection RE... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3714273 Wed, 30 Jun 2010 13:17:00 +0100 3714273 http://www.medworm.com/index.php?rid=3706751&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fivf-making-sense-of-treatment-cycle.html Open publication - Free publishing - More infertility (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3706751 Tue, 29 Jun 2010 06:04:00 +0100 3706751 http://www.medworm.com/index.php?rid=3706752&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fdoctor-what-went-wrong.html Whenever an IVF cycle fails, the first question the patient demands an answer to is - Doctor, what went wrong ?Some doctors get defensive when they hear this question. They feel the patient is challenging their clinical competence, and many will simply refuse to see the patient when the IVF cycle fails. This is adding insult to injury, because they have abandoned the patient in their time of need, simply because they do not feel comfortable answering uncomfortable questions. ( Many of this breed of doctor would rather spend their time doing consultations with new patients, so they can do more IVF cycles !)Some will blame the patient - either subtly, or otherwise. " The embryos did not implant because you did not rest enough". Some doctors will use this as an opportunity to "run some more t... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3706752 Mon, 28 Jun 2010 09:24:00 +0100 3706752 http://www.medworm.com/index.php?rid=3701731&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fafter-4-failed-ivf-cycles-what-should-i.html Mrs Desai was in tears. She was very depressed and agitated. " Doctor, I have done 4 IVF cycles in 3 different clinics and they have all failed ! What should I do next ? Is there any hope for me at all ?"I see patients like Mrs Desai every day. I try to help them analyse their problem , so they can find the right solution.Step No 1 is to use the McKinsey MECE model of exploring all their options - making a list which is mutually exclusive and completely exhaustive. In most cases, this list would include the following options:- childfree living- adoption- medical treatment ( IVF)- third party reproduction ( IVF with donor eggs or donor embryos or surrogacy)Typically, most patients who come to me are willing to consider only the last 2 options.As I explain to them , for their next IVF cycle,... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3701731 Fri, 25 Jun 2010 12:11:00 +0100 3701731 http://www.medworm.com/index.php?rid=3695647&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fworlds-first-virtual-ivf-clinic-on.html We have created the world’s first IVF clinic on Second Life. The clinic is now open – please do come and browse around ! We have a reception area where you can watch videos about IVF a consultation room, where you can do a consultation with a virtual IVF specialist an operation theater, where you can watch an egg collection and embryo transfer an IVF lab, where you can see how embryos grow an andrology lab where you can see how we process sperm for IUI a PGD lab, where you can watch how we do an embryo biopsy a virtual support group, where you can get counseling and support Go to Second Life ( www.secondlife.com) and set up a free account. Use the link below to get to the clinic once you in Second Life http://slurl.com/secondlife/Nileswarm/40/... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3695647 Thu, 24 Jun 2010 15:09:00 +0100 3695647 http://www.medworm.com/index.php?rid=3687187&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fone-thing-every-patient-needs-to-know.html IVF can be a complex process and selecting a doctor can be quite a challenge ! Infertile couples are often frustrated and depressed and most will choose an IVF clinic based on a recommendation by a friend or a referral by a doctor. This is not always the best method and you can end up getting stuck in a poor quality clinic, thus reducing your chances of success. Even worse, many clinics do precious little do educate or inform their patients and patients don't know what questions to ask their doctor.Also, IVF cycles can fail for many reasons. Sometimes the problem is poor quality eggs - but often it is a poor quality clinic !Here's the single most important thing you should check, to be sure you are getting good quality treatment.Insist that your clinic provide you with photos of your embry... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3687187 Tue, 22 Jun 2010 07:53:00 +0100 3687187 http://www.medworm.com/index.php?rid=3683702&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fall-about-ivf-part-1.html Open publication - Free publishing - More infertility (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3683702 Mon, 21 Jun 2010 08:14:00 +0100 3683702 http://www.medworm.com/index.php?rid=3679819&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fhindustan-times-special-surrogacy-not.html This is great news ! This will allow good IVF clinics to offer surrogacy ethically within a legal framework - and hopefully will help to protect infertile couples ( the intended parents) and the surrogate as well ! read more... (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3679819 Mon, 21 Jun 2010 04:58:00 +0100 3679819 http://www.medworm.com/index.php?rid=3679820&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fdoes-cat-help-to-improve-ivf-pregnancy.html IVF patients are always on the lookout for innovations which will improve their chances of success . For example, many IVF patients ask us whether we do IMSI or CAT. These are techniques which have been aggressively promoted in the press, but do not really help the patient at all. I have written about IMSI in an earlier post. Let me discuss CAT ( cumulus-aided transfer) in this post.IVF doctors have always been frustrated by the fact that though we are quite good at growing embryos in the lab, most of these embryos do not become babies. Embryo implantation is an inefficient process, and trying to ensure that every embryo we transfer becomes a baby is the "holy grail" for all IVF specialists , which is why we use techniques such as blastocyst transfer and laser assisted hatching, to try to ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3679820 Sun, 20 Jun 2010 12:07:00 +0100 3679820 http://www.medworm.com/index.php?rid=3678583&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fhow-to-increase-your-stress-levels-when.html Being infertile is stressful - and going through an IVF cycle can be even more stressful, because so much is riding on the outcome of the treatment. While the actual medical treatment in an IVF cycle ( shots, scans , pickup and transfer) is not physically taxing, the emotional demands ( because of the hopes, dreams, desires, fears which are such an integral part of all infertility treatment ) can exact a huge toll.The one factor which causes the most stress is having unrealistic expectations . Every patient feels in their heart of hearts that " this is the cycle when it's going to work !" - and I do not think any one would ever start an IVF cycle if they did not feel it was going to work. Unfortunately, the only thing which is in your hands is the process. You can make sure you have a comp... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3678583 Sat, 19 Jun 2010 09:55:00 +0100 3678583 http://www.medworm.com/index.php?rid=3671811&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fhow-ivf-doctors-misuse-ultrasound.html A vaginal ultrasound scan has now become a routine part of the work of an infertile woman, because it provide so much useful information. Unfortunately, many IVF specialists misuse this simple technique.I have seen patients who have been advised donor eggs by IVF doctors, because their "ovaries looked small" on the vaginal scan done at the time of the consultation . Even worse, is the fact that some doctors advise surrogacy because " the uterine lining is thin".They do not bother to provide any documentation of their scans - or to explain options and alternatives to their patients. Most patients are quite easily initimidated; and since the IVF doctor is seen to be the "court of last resort", many follow the doctor's advise blindly or get disheartened and give up.In fact, some clueless pati... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3671811 Thu, 17 Jun 2010 10:00:00 +0100 3671811 http://www.medworm.com/index.php?rid=3662761&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fsigns-of-bad-ivf-clinic.html We see a number of patients who have failed IVF cycles elsewhere, so we have a fairly good idea of what makes some clinics bad.Here's a short list of features which can help you identify a poor quality IVF clinic1. Clinics which depend upon outside embryologists to do their procedures for them. IVF is a demanding process and your embryos need the full-time loving care and devotion of an experienced embryologist. A full-time embryologist spends a lot of time honing his skills and optimising the conditions in his IVF lab to ensure high pregnancy rates. This is not something a "visiting embryologist" can do. Thus, these clinics will very rarely freeze spare embryos , and your supernumerary embryos are usually discarded - or donated ( without your content or permission) to another patient.2. C... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3662761 Tue, 15 Jun 2010 14:29:00 +0100 3662761 http://www.medworm.com/index.php?rid=3659020&cid=t_105306_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F06%2Fis-there-any-need-to-remove.html Image via WikipediaMany women with blocked tubes go in for IVF treatment . Some of them have a hydrosalpinx, in which the blocked tube is filled with fluid. It has now become standard advise to remove the hydrosalpinx or to clip the blocked tube prior to IVF. This needs to be done by performing an operative laparoscopy ; and this procedure is supposed to improve IVF pregnancy rates ( because the hydrosalpinx fluid is toxic and can prevent the embryos from implanting.)Most gynecologists are happy to advise this surgery before referring the patient for IVF, because this is an additional surgical procedure for which they can charge the patient. In reality, however, this unnecessary surgery can actually end up causing harm.For one, it leads to overtreatment. In many IVF clinics, all blocked tu... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3659020 Mon, 14 Jun 2010 14:20:00 +0100 3659020