Malpani Infertility Clinic

Infertile patients know that IVF is a complex and expensive treatment. It requires a lot of experience and expertise in order to maximize the success rates. They also know that different IVF clinics have different success rates, and that there is a big difference between the pregnancy rates of a good clinic versus a bad clinic. This is why they spend so much time trying to find the best IVF clinic with the highest success rate.

However, in spite of this, many patients do a poor job in selecting the right IVF clinic. There are multiple reasons for this.

Firstly, some patients still naively believe that all IVF clinics are equally technically competent. This can be a major mistake. For example, most IVF clinics in India still do not even have a full- time embryologist, and have to batch their patients in order to use the services of a travelling embryologist.

Patients need to invest enough time in Information Therapy and doing their homework, so they can learn to ask intelligent questions about their IVF treatment, rather than just unquestioningly accept whatever their doctor tells them. Sadly, it’s only when a cycle fails that they realize the importance of being well-informed – but by this time, the damage has already been done

Most patients still select clinics based on convenience – they choose the clinic, which is closest to them. While this does make dealing with the logistics a lot easier, it also means that while this may be a sensible short-term decision, if the local clinic has a poor pregnancy rate, they will end up wasting a lot of money.

Most patients are happy to go to their family doctor or gynecologist and request them to refer them to an IVF clinic. They naively trust their local family physician, and believe that he will refer them to the IVF clinic which is best for them . Little do they know that today a lot of family physicians and even gynecologists will refer patients to IVF clinics which offer them a kickback to do so.

This means that sadly patients can no longer trust their doctor to look after their best interests, because he is busy looking after his personal financial interests.

One of the reasons patients cannot differentiate between a good clinic and a bad clinic is because they do not bother to invest time and energy in learning the what differentiates a good clinic from a bad one.

Here’s a simple tip. A good IVF clinic routinely provides photos of embryos to their patients. Any clinic which does not do this is not likely to be a good clinic. When patients think about how much time and money and energy they are investing in their IVF treatment, they should be willing invest a little bit in the Information Therapy as well , so they can learn what makes a good IVF clinic good.

Many IVF clinics in India continue to routinely transfer four or five embryos during the IVF treatment, even in young patients who are doing their first IVF cycle. This is worrisome, because the risk of these patients having a multiple pregnancy after the transfer of so many embryos is extremely high. Many will end up having triplets, when they run the risk of having babies with lifelong disabilities because of their preterm birth. Others will end up miscarrying after a selective fetal reduction.

The Best IVF doctor, on the other hand, will proudly count the pregnancy as being a success, when in real life, it’s actually been a disaster for the patient. This is because the doctor does not have to provide the pregnancy care or look after the preterm babies, which means he is often blissfully unaware of the adverse consequences of his actions.

The fact that the clinic is willing to transfer so many embryos is actually a sign that this is not a good clinic! This is because they don’t have enough confidence in their lab, and are forced to resort to transferring so many embryos, in order to artificially inflate their success rates. A good clinic is able to create good quality embryos, which have a high implantation rate.

Patients contribute to the problem by pressuring doctors to transfer more embryos, because they feel this will improve their chances of having a baby. Most are so fed up of not ever getting pregnant, that they are willing to risk the possibility of a multiple pregnancy and feel that anything is better than not getting pregnant. Little do they realize that by doing so, they have pushed themselves from the frying pan into the fire. Please remember that transferring more embryos does not increase success rates – all it does is increase the risk of a multiple pregnancy . More is not always better!

A good clinic will usually transfer just one embryo (if it's a top-quality blastocyst). For selected patients (for example, those who are older or those who have failed many IVF cycles, they may be justified in transferring more embryos).

A clinic which routinely transfers an excessive number of embryos is a bad clinic because they are not confident about their embryo implantation rates.

In a good clinic, 50% of top quality blastocysts will implant successfully. This means their implantation rate is 50%. The reason the other blastocysts do not implant is because they have a lethal genetic problem (which we cannot identify) causes them to stop growing and prevents them from implanting.

This is why we still cannot predict which blastocyst will become a baby. This is also why transferring three blastocysts would give an extremely high success rate – but would also result in a very high number of multiple pregnancies.

A good clinic, which has a higher pregnancy rate because it creates top quality embryos with a high implantation rate will discourage patients from transferring too many embryos, because they are confident they will have a high pregnancy rate even after transferring just one or two embryos. Even better, the spare embryos are not wasted. The supernumerary embryos can be cryopreserved safely, and used later on to complete your family!

Worried that your IVF doctor wants to transfer too many embryos and that he is taking the risk of a multiple pregnancy too lightly?

Is Adoption a good solution for infertile patients?

Most fertile couples are blissfully unaware of what infertile couples have to go through in order to have a baby. They are not aware of the suffering which infertility causes; and have no clue about the treatment options available for infertile couples.

They will often be flippant about infertility - and will often provide "advise" to infertile couples which can be heartbreaking. While they may not mean to be cruel, their insensitivity can cause a lot of pain and heartbreak.

Thus, many people advise infertile couples to just adopt a baby. They say stuff like – Isn’t this a much better and kinder thing to do.

Rather than take painful injections?

After all, what could be nobler than provided an unwanted baby with a loving home?

If I didn’t have children of my own, I would definitely have adopted a baby, rather than go to an IVF doctor!

Many people naively believe that the process of adoption is as easy as picking up a beggar child off the street and taking him home. They do not know what a complex process adoption can be – and how long the waiting lists are.

In reality, the number of children who are being put up for adoption is going down dramatically every year. This is because the number of unwanted children is on a sharp decline due to advances in contraceptive treatment. Most women who find they have an unwanted pregnancy choose to safely terminate the pregnancy , rather than continue with it. The children we see begging on the streets are not up for adoption! They are economic assets to their families, rather than being unwanted because they earn money for their families by begging, selling newspapers or used plastic bags. As a result the adoption agencies have a long waiting list of infertile couples.

The adoption decision involves intense soul searching by the couple, along with the wholehearted support of the relatives. If the couple chooses not to adopt, please respect their decision and appreciate that they have invested a lot of thought into this!

The good news is that even though adoption a baby has become increasingly difficult, it’s now possible for infertile couples to complete their family using the process of embryo adoption! Not only is this much less expensive than traditional adoption, there’s no waiting list involved either. Even better, since the woman carries the pregnancy herself, she can experience the joy of motherhood!

Natural cycle IVF and Mini IVF are safe, repeatable, budget friendly treatment procedures with good success rates in patients with poor ovarian reserve.This is a kinder, holistic approach, which takes advantage of your body's own hormones!

Natural cycle IVF is a simpler way of doing In Vitro Fertilization. It is especially of benefit to patients with poor ovarian reserve. These patients have a limited ovarian reserve and do not respond well to conventional superovulation with gonadotropin injections.

Natural cycle IVF or gentle IVF is a procedure done using minimal or no ovarian stimulation. It is a procedure with few side effects; is less expensive; and can be repeated; and has good success rates over a period of time, in expert hands. It is important that the patient is treated by IVF specialists who are completely aware of the challenges involved in this type of IVF. The procedure is quite demanding in terms of timing egg retrieval and fertilization of the egg. The procedure will fail if any, these factors are not monitored properly.

At Malpani Infertility Clinic, we are expert at ensuring you have the highest chances of success. We have a treatment schedule and protocol that we strictly follow for patients who come in for natural cycle IVF.

1. We do a vaginal ultrasound scan on day 7. This scan shows the follicular size and thickness of the endometrium, which confirms that you have a viable and growing follicle.

2. When this is confirmed, we start you on a GnRH antagonist medication to avoid untimely LH surge.

3. We do the next scan and an E2 blood test on Day 10.

4. Once the follicle size is 18 mm and E2 level is 200pg/ml, we give you the HCG trigger shot.

5. The egg collection is done 36 hours later.

6. The egg is fertilized by our expert embryologist and the embryo transfer is done within 48 hours.

Another option with better pregnancy rates is a mini-IVF. It involves mild super ovulation to ensure the growth of 2-3 follicles. At Malpani Clinic the treatment plan for mini IVF is similar to natural IVF with some additional medical treatment. The first scan is on day 2 to confirm downregulation and absence of any ovarian cysts. You are then put on Letrozole from day 2 to day 6 and managing from day 3 onwards. The next scan is on day 7 and the rest of the procedure is similar to the one followed for natural cycle.

One of the hardest things for an infertile couple to deal with is the failure of an IVF cycle. In fact, it's the fear of failure which often puts off a lot of infertile couples from even attempting an IVF cycle. They are petrified that if they try and fail, they will have nothing to fall back on, which is why they refuse to even make the attempt in the first place!

You are likely to go to pieces when you cycle fails, because all your hopes come Shattering Down. Please give yourself time to recover – and then seek a follow up appointment with the doctor, so you can assess what you learned from the cycle. Sadly, the quality of IVF medical records in most Indian clinics is abysmally low. It’s important that you proactively ask for all your IVF medical records and documentation while the IVF treatment is going on, rather than beg for these papers after the cycle fails. The rule is simple - You must demand a printed treatment summary for your IVF treatment at the time of the embryo transfer itself. This should include basic details such as:

What were the meds which were used for superovulation?

What was their dose?

How many follicles did you grow?

How many eggs were collected?

What was the E2 (estradiol) level in the blood?

What was the endometrial thickness?

How many embryos were transferred?

What was the embryo quality?

Were any embryos frozen?

Please insist that your clinic provides you with photos of your embryos. 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. If you are well-prepared, you will not go to pieces even if your first IVF cycle fails. You need to analyze your medical records and do your homework, so that you can ask your doctor intelligent questions at the time of your visit.

What went right?

What went wrong? Why?

What does he plan to do differently in the next cycle?

Were there issues with superovulation?

Egg retrieval?

The embryo transfer?

Embryo quality?

Do you have spare frozen embryos?

It’s very helpful to have pictures of your embryos to make sure this is an intelligent discussion. If your doctor tries to fob you off by just airily saying that the embryos were of good quality and refuses to give you photos of your embryos, this should raise a red flag!

Many issues seen in a failed first IVF attempt can be addressed in order to eliminate or reduce the likelihood of the same issue occurring in a second try with in vitro fertilization. Not all issues are "fixable" - but they should be studied and discussed, so that you are educated about your options and can make a well-informed decision. After a failed IVF cycle, the commonest question is

What is the success rate with a second cycle of IVF? This is a simple question – but there is no easy answer. As with most things in medicine, the truthful answer is – It depends. Many couples will have a successful second IVF.

The chances depend upon many factors, including:

Egg quality and egg quantity which depends upon your age; and the skill of your IVF doctor in managing your superovulation.

Sperm quality, though this is much less of an issue when we do ICSI.

IVF lab quality.

Egg retrieval skills of the physician.

Embryo transfer skills of your IVF doctor.

Uterine issues.

Genetic and chromosomal competence of the embryos.

In order to maximize the chances for a successful second IVF try to make sure that your doctor has carefully reviewed the issues above. If there were difficulties with the ovarian stimulation or low numbers of eggs - consider modifications to the drug protocol. If there were good looking embryos, but none implanted, try IVF a second time at the same IVF clinic. If there were significant embryo quality issues, it is most likely due to an IVF lab quality control problem. Therefore, consider changing the IVF clinic to a program with higher in vitro fertilization success rates to see if these issues can be corrected by a better IVF lab.

Using donor eggs, or donor embryos could be future considerations, but these are usually part of Plan C. While many patients feel surrogacy is a useful solution for treating failed IVF, the truth is that the uterus is very rarely the problem. Implantation failure is almost always because the transferred embryos were too weak to implant and continue normal development. The uterus is almost always receptive to embryo implantation.

What about ordering more tests, to try to find out why the cycle failed?

What about using supplements to try to improve egg quality?

Is it reasonable to use experimental unproven treatment options, such as immune therapy to “treat” high NK cells, which allegedly prevent embryos from implanting by causing immune rejection? While patients can get frantic in their search for answers, the truth is that because embryo implantation is still a black box area about which we know precious little, we cannot determine the commonest cause for IVF failure, which is why we use the catchall term, “failed implantation.” This is actually a waste-paper basket diagnosis, because it provides precious little useful actionable information for the patient. It’s just a “scientific” dressed up label, which doctors use to pacify their patients. All it means is – that the embryos did not implant, and we do not know why. The good news is that if you had a perfect IVF cycle (good embryos; good uterine lining; and an easy transfer) then just because the first IVF cycle fails, the chances of success remain equally good in the second and third cycle! In fact, the fact that you created good embryos emphasizes the fact that you are capable of getting pregnant – and sometimes you just need to be patient to have a baby. Remember that most IVF babies would never have occurred if the couple had stopped at the first cycle of IVF. There is data, however, that suggests that after 4 failed cycles, the chances of conception do become lower and lower and you should start considering third party options (such as donor eggs or donor embryos or surrogacy). Remember, that the failed IVF cycle will not just teach you about how to improve your chances of success in your next IVF cycle – it will also teach you a lot of valuable life lessons! Whenever you step outside your comfort zone and try something new like IVF, failure is always a possibility. However, the fear of failure can be a much bigger burden to carry – and even if you fail, you will have peace of mind that you did your best. Each failure brings you one step closer to reaching your goals – and also allows you to put your life in perspective. Life does not end just because the cycle failed – and a failed cycle does not mean you are a failure either ! Each failure makes you stronger, bigger and better and making mistakes is not a big deal as long as you learn from them and avoid repeating them. No matter how often you fail, you are not a failure as long as you don’t give up – and each time you fail, your fear of failure becomes smaller, which allows you to take on even bigger challenges. Overall, IVF success rates are about the same on the average for second attempts as compared to the first IVF tries. Good IVF doctors can learn a lot from the failed IVF cycle, and they can intelligently use this information to make adjustments to maximize success for the second in vitro fertilization attempt. They understand that while they cannot control the outcome, they can control the process.

You hear IVF success stories every now and again but I'm sure ours will be a super duper one!!!

We, Susan and Sunil Silva got married 11 years ago, we didn't have (any biological) kids because my husband had undergone a vasectomy in his previous marriage, after fathering 2 boys. The elder one is with his ex while the younger one chose to be with us- apple of my eye, my son! About 7 years ago we started thinking about having one more child and decided to give it a try undergoing an ivf! I started reading and searching for best IVF clinics in the internet and always Dr Malpani's clinic came first in the list and I literally developed a virtual faith/trust to that clinic. Moreover the advice/second opinion which I got from Dr Malpani boosted my confidence and I was damn certain I want to go to Malpani's for my ivf. Unfortunately my husband was dead against about the idea of going to Mumbai for an ivf when there are n number of ivf clinics in Chennai itself! So we tried ivf in a clinic here in Chennai where which not only wasn't successful but also the whole episode highly unprofessional. There was absolutely no transparency as far as the treatment was concerned and we just left the idea of trying another cycle for a while then.

Then two years ago we decided to try another cycle (better late than never!) and this time my husband let me decide on the clinic (I made his life miserable enough for for 2 years for not listening to me, so much so that he would've taken me to moon if that's where I wanted to go for my ivf! ;)!!!

There was no doubt in my mind where I wanted to go! I landed in Mumbai on June 2012, the first meeting up with Dr Malpani it made me think extremely positive about the whole exercise. I got conceived in the first chance itself with TWINS!!! I gave birth to my baby boys Jordan and Aidan in Feb 2013!!! Yippee!!!

The story doesn't end over here! My brother was diagnosed with obstructive azoospermia about 4 years ago and was left with no choice but ivf in order to have a child of his own! Both my sister in law and my brother tried an ivf cycle in Kerala (against my advice on Malpani clinic) 3 years ago which was again a failure.. So vague that clinic was, they haven't even got a treatment copy from there!

Seeing me pregnant with twins, they too wanted to try their next cycle in Malpani's. They both started their treatment on June 2013, exactly a year after my visit!

And my sister in law is now six months pregnant with TWINS!!!!! Yippee Yay Yay!!!! (Moral of the story is taking me my advice seriously!

For successful in vitro fertilization treatment, egg quality is very significant

It is well known that younger women have higher IVF pregnancy rates . Their success rate is better both because they have more eggs; and because these eggs (oocytes) are of better quality. This is why when they do in vitro fertilization treatment at a test tube baby center, their chances of having a baby are higher, as compared to older women, because they produce better quality embryos , in higher numbers.

For IVF treatment, the dream patient with the best prognosis , would ideally be a young woman with a good ovarian reserve of eggs. Second best are young women, even if they have fewer eggs, as the quality of these is more conducive to fertilization, when compared to similar eggs from an older woman. In most older women, the quantity as well quality of the eggs leaves much to be desired when doing in vitro fertilization.

The problem with eggs is that it’s hard to assess their quality when they are checked in the IVF lab afrer retrieval by the embryologist. Under the microscope, they appear as spherical blobs, and the IVF scientist cannot look at an egg and say whether it is of good quality or bad, because they both look the same. The key difference between good eggs and bad eggs is the functional competence of their intracellular powerhouses called mitochondria. Unfortunately, we cannot test for how well these function as yet. It is only after they are fertilized with the sperm, when the embryologist does a fertilization check on Day 1, that we can distinguish good eggs (the ones which fertilise) from the bad ones (those which do not fertilise). Moreover, while some eggs may go on to fertilize, they embryos they give rise to may not divide well, and this can also be assessed by grading the embryo quality on Day 2 in the IVF lab.

Because the proof of the pudding is in the eating, this means the quality of an egg can be confirmed only by assessing the quality of the embryo which results after its fertilization. Poor quality eggs result in poor quality embryos that are fragmented and divide slowly, as the mitochondrial energy is not able to drive normal cell division. It is possible that cytoplasmic donation could be a key to this problem, but at present, donor eggs are the best solution for older patients who fail in vitro fertilization because of poor egg quality. An egg is considered to be good only if it turns into a good quality embryo. Likewise, an embryo is said to be good only if it becomes a baby after transfer. However, this is still unpredictable.