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Monday, July 18, 2016

Dr.Malpani's Blog: Book Release - Patient Safety - Protect yourself f...

Dr.Malpani's Blog: Book Release - Patient Safety - Protect yourself f...: Please do come to our book release - Patient Safety - Protect yourself from Medical Errors on July 19 at KEM Hospital at 2 pm. This will...

Monday, July 11, 2016

Detox your way to IVF conception

I went through a website which is very popular among infertile women. They offer nutrition and exercise advice ; sell imagery CDs - which they claim , " they are as powerful as fertility drugs " ; and moreover , they offer emotional support. So , it's a complete package - and , it's completely natural ! They call it as natural fertility treatment. How I wish I could start something like that - who doesn't want to earn money !
Their website is full of word play - you get nothing useful from there until you pay money. And even if you pay , I wonder , what you will get out of it ! But nevertheless , they are very famous and have many glorious testimonies to their credit !
Let me come to the point - how to detox your body ? Before that , let me ask you some questions :
1. Do you have a very stressful life ?
2. Don't you eat organic food ?
3. Do you eat genetically modified food ?
4. Do you use lots of chemicals at home - shampoos , cleaning and washing lotions , soaps , etc., ?
If your answer is 'yes' for the above questions , it clearly shows you have poisoned your holy body ! This is the reason why so many diseases exist in modern world - from cancer to infertility ! It's a punishment imposed on humans for going against nature. Your body has accumulated so much of toxins - as a result , your ovaries have stopped functioning properly ; your embryos haven't implanted because your uterus is not embryo friendly as a result of all the toxins it has accumulated over the years ! If you could get rid of these toxins , you get your fertility back !
On reading the above , how many of you feel scared ? How many of you feel guilty ? How many of you are wondering what I can I do to get rid of the toxins ? This fear and guilt you feel is the raw material for many peoples' business - and unfortunately , many fall as prey for such scams , yes , scams !
Why do people believe such scams ? The foremost reason is , they lack knowledge about how human body works. Next comes the glorious advertisements and testimonials they see , read and hear - and ,  when it comes from a friend or doctor they trust , they easily fall for it.  The third is , when they meet a person who claims that treatments like detoxification works , and sells it too , they get carried away by their bedside manners - their promises , concern , care , consideration , reassurance and sympathy can feel like an oasis in their desperate attempt to hold on to hope and faith. As a result , many turn out to be loyal customers even if the treatment doesn't lead to what they wanted - they will find ways to suppress their rational part of the brain , because , all they remember is how emotionally pampered they are when going through such treatments. They stay loyal forever irrespective of the outcome !
Our body has amazing ability to remove any harmful substances that enters in. Organs like liver , kidney , skin , lungs , etc ., work to remove all the waste products that form in our body as a result of digestion and metabolism. The detoxification programmes claim that they help your body to eliminate wastes ( toxins ) better by making your liver and kidneys function better. They sell several herbs  and supplements for the same - and , what attracts people most is the word ' NATURAL .' Unfortunately people fail to understand that natural doesn't mean it is without unpleasant side - effects ; natural doesn't mean it's free of harmful chemicals ; natural doesn't mean it's safe. Actually , the herbs , herbal cocktails , vitamins and other supplements sold by them doesn't have FDA approval. This means ,  they are not checked for the ingredients they claim that it contains ; they are not checked for appropriate dosages - and hence there is no guarantee for their safety or efficacy. As a result , they can actually prove to be much harmful than you might imagine ! You are in danger of not only loosing your hard- earned money but also your precious health. You can't enhance your liver or kidney's ability to clear wastes. If your kidney and liver function tests are normal , they are working just fine. Just because your liver and kidney cleans your body's metabolic wastes , doesn't mean they accumulate toxins and slowdown in function  ! You do not have to detoxify  them regularly in order for them to work properly.
Organic food doesn't means it's pesticide free. Produce that are not organic is perfectly OK to consume after washing them ( of course you have to wash the organic produce , too ) . By consuming them you are not accumulating toxins in your body ! Organic food is definitely not more nutritious - it is just more costly ! Genetically modified food is not poison. No one will get cancer by consuming them , nor do they carry toxins ! Genetically modified foods don't deserve the negative propaganda they are receiving by the people who really don't care to understand how genetic engineering works ! I have learnt from some infertility forums that some patients' IVF doctors have insisted that they go organic and remove all chemicals from their lives ! How unreasonable such suggestions are ! How easily doctors too fall for cognitive biases ! Or , is it a strategy they ploy to blame their patients' life style for the IVF failure ?
Just like , you can't detox your way to IVF conception , you can't use your visualization power to bring on a powerful ovulation ; you can't use imagery CDs to make your egg quality better ; you can't make your embryo stick by imagining that they are doing so ! If it works so , majority of us don't need an infertility doctor.
So , why so many patients swear by the efficacy of such unscientific practices ? The answer is simple , those websites provide enormous emotional support. They give you so much personal attention and reassurance , provided , you pay them ! When we are going through a difficult journey , we all need someone to hold our hands and say that all will be well and we can get through it ; we need real life examples , real life success stories ;. and moreover ,  we need someone with whom we can can confide our fears , insecurities , hopes and dreams. They offer all this ,  and much more. I feel they work like a cult with their own unscientific doctrines and principles. They know how exactly to brainwash their customers. Since , infertility is an emotionally  stressful and tiring journey , we easily fall for their promises. Infertility makes us emotionally vulnerable. Many of us lack proper support system when infertility strikes - it is still a taboo in many parts of the world. All these factor earns a lot of customers for such quacks.
When you find yourself getting lost in the stress of infertility , please try to do the following :
Educate yourself about your problem scientifically - this will help you to build realistic expectations , it will also strengthen your hope and make you confident.
Have an open mind and have alternate plans  - don't get desperate for success !
Build proper support system - your family ,  online infertility forums and your doctor can play a major role in keeping you sane and hopeful , amidst the enormous stress.
Please do not waste your emotional and financial energy by believing in quackery ! You can ask me , " If , what they offer makes me feel better , if I find solace there , why not follow it ? "  The problem here is ,  people who sell such ' alternative therapies ' claim that it can make you conceive or make you fit for conception , which is totally false. They are promoting something which is not scientific and trying to make a business out of it by playing with your emotions.  I understand that we need to find a middle path - but , middle path doesn't mean you need to mix delusion and reality and end up with heart ache when the treatment doesn't work ! Mixing placebo sugar solution and real medicine isn't going to enhance the medicine's effect , it can even make the medicine ineffective - that's not the real middle -path ! Many a time , alternative therapies distracts you from your real goal.  The real middle path is , understanding your problem , working on what you can really improve scientifically and let go of things what is not in your hands ( for example , if your ovarian reserve is exhausted and your ovaries are no more responding to drugs ! ) - instead of repeatedly hitting the dead end and wasting your physical , financial and emotional energy. When you hold on to false promises and hopes for support , when you fall , you fall really hard - the pain will be enormous. When you hold on to reality , even if it is bitter to accept , when you fall , you do so gracefully - the pain will be lot lesser and you will spring back to action very soon.

Thursday, July 7, 2016

Elective Single embryo transfer ( eSET ) - is it for me ?

The answer to this question depends on a number of factors :
1. Your age
If you are of young maternal age , the chance that more than one of your transferred embryos being genetically normal increases. Hence , it is wise to opt for single embryo transfer ( SET ). If you are less than 35 years of age , with good ovarian reserve and good quality embryos , you must consider transferring only one embryo.
2. Your ovarian reserve ( the number of embryos obtained in a particular IVF cycle )
If you get many eggs and embryos in your IVF cycle , it is better to grow them to blastocysts and do a SET.
3. Having good looking embryos
If the embryos that were created are of high grade , then doing eSET can be beneficial, provided , you are of young maternal age with good ovarian reserve.
4. Blastocyst transfer
If 40 % of your embryos develop into blastocysts , it shows that they are following a normal growth pattern. In such cases , elective SET can be beneficial.
5. Your clinic's success rate
If your clinic has high success rate for women of your age , then it is important to listen to your doctor's suggestion regarding how many embryos to transfer. You have high chance of having multiples if you transfer more than one embryo in a clinic which has high success rate.
6. When using donor eggs and embryos
Women who donate eggs are usually of young maternal age , so , the chance that many of the obtained embryos are genetically normal increases. Donor embryos are mostly got from couples who have completed their families using the same cohort of embryos. This is a sign that the remaining embryos may be good enough , too. And moreover , majority of the time , only couples who are of young maternal age will have ample embryos to donate  . So , when using donor eggs and embryos , it is good to go with single embryo transfer.
7. When using embryos which are tested for genetic competency
When using embryos which are tested using advanced genetic testing techniques ( for example , embryos tested using NGS ( next generation sequencing,  where all 23 pairs of chromosomes are screened )  , SET must be preferred.
In short , if you are of young maternal age ( ideally , below 35 years ), with good ovarian reserve ; if 40% of your obtained embryos grow to blastocysts and are of good grades allowing you to select the best ; if you use embryos which are tested for chromosomal normalcy ,  and if you are with a clinic which has high success rate , or , if you are using donor eggs and embryos , you must opt for SET - this will greatly reduce your chance of having multiples. 
Remember , a successful IVF cycle is not about getting a positive pregnancy test. Only when you take home a healthy baby ( healthy babies )  healthily , your goal has been achieved. Multiple pregnancies can be  disastrous , many a time.  Having premies in hand is heart - wrenching and losing healthy babies can break your heart. The chance of something going wrong in multiple pregnancies is several times higher when compared to singleton pregnancy. So , aim for eSET whenever possible - aim for a healthy IVF pregnancy.

Tuesday, June 28, 2016

Happy Birthday , Dr !

Dear Dr ,

Many more happy returns of the day ! May you live a very long , happy and healthy life , and let no harm come near you. May all your dreams and ambitions come to fruition. Keep smiling , and have a very beautiful life ahead !

Thanks a lot for making Anisha happen ! She has made our life happier and purposeful. We learn a lot from her , everyday. Not even a day goes by without wondering how dull and colourless our life would have been without Anisha ! Thanks to you and your team for all the technical help and support !

For me , your presence has been a great support. When I was shattered beyond words by the loss of our twins , the thought that you are there gave me enormous strength. I wouldn't have fought this battle gracefully without your blog , my blog and you. Thank you , you are a wonderful doctor , and moreover , a beautiful human being.

Have a great day , Dr ! Stay blessed , always.


Saturday, June 25, 2016

Wednesday, June 22, 2016

Can stress cause infertility , can the stress of infertility treatments prevent my conception ?

This is the most disturbing question in the minds of men and women fighting infertility. The most important piece of advice you will receive from well - meaning people , when you are struggling to conceive is , " Relax , it will happen ". Even if you are reacting to your situation normally , like every human will do , the ' relax ' advice makes you to worry that you are worrying too much about getting pregnant ,  and hence that stress has come as a stumbling block to conception. Once you start to believe so , you will be stressing all the time not to stress ( instead of working on your stress to make the situation better ) ; you will be worried about how not to worry - as a result , you will slowly be caught in a stress cycle which is not productive. Worrying how not to worry , instead of reacting to the situation appropriately , can never lead to any constructive action , unfortunately !
We are all made to believe that stress is bad for us. The truth is ,  stress is an inevitable part of human life , it helps us to become courageous , it makes us caring and empathetic , and most importantly it makes us resilient ( that's what the new research says ! )  What else do you need to fight infertility ?
The idea that stress is toxic to our body is an old school of thought. As scientists developed proper models and tools to explore further into stress and it's effect on our body , it became clear that stress is not bad , after all. It is our body's defense mechanism to cope with difficult situations. Stress actually makes us healthy - it boosts our immune system , makes us physically and mentally resilient and has a positive impact on our brain health.
Further more , research has also pointed out that , people who believe stress is bad for them tend to experience the negative side - effecets of it ,  and people who think stress helps them to perform better , reap the best out of it. How can it be ? For example , if a person going through infertility treatment starts to believe that the stress of the treatment is causing him / her  not to conceive , they naturally quit their treatment. This happens many a time. People start to believe that the stress of infertility treatments is stopping them from conceiving. Once such a thought enter their mind , they quit treatment and try to take a route which is least stressful - for example , natural cures ( homeopathy etc ).  If the cause of their infertility needs allopathic treatment , they will never conceive in spite of their decreased stress ( for example , if the problem is blocked tubes or low sperm count ). In such cases , their belief that stress is harmful hindered their ability to endure difficulty and fight back. The end result is ,  they end up wasting their precious fertile years and unintentionally decrease their chance of conception. On the other hand , people who accept their stress caused by infertility and use it in the best possible manner will tend to achieve their baby dream much more easily. This is because , they are least likely to give up , they remain energetic , stay focussed and motivated. They rise to their challenge and give their best. They can also use their stress to become best care givers for people who are in a similar situation as they are.
There are three beneficial stress responses ,  ' challenge response ' is one among them. This stress response reduces inflammation and helps you to rise to your challenge. So consider your infertility as an interesting challenge and make the most out of your beneficial stress. To give a simple analogy , imagine a mad dog running towards you. You have two options : you can try not to stress yourself too much and wait patiently for the dog to approach and bite you , or , feel the stress and respond accordingly by running as fast as you can to escape the ferocious dog ( the challenge here is to run faster than the dog ) ( although ' a dog chasing ' is a type of threat response , I have used it as an analogy for ' challenge response ' )
If someone tells you that stress is bad for you , please do not believe them. Stress is not bad. It is not evolved to harm you and your body , but to help you. Nature wouldn't want the human race to end , nature wants that we thrive and flourish. If stress is so bad for us , our body would have developed mechanisms to evade stres all together.
When infertility strikes you , it is a very normal reaction to worry. Worry leads to further actions - you find a doctor , you read a lot about it , you ask for multiple opinions , and you spring into action. If someone says that this is wrong and you must relax , something is wrong with them and not with you ! Except for the threat response , aka , fight and flight response , no other stress response leads to a toxic state. During threat response , it's true that inflammation is increased , our decision - making ability is impaired , hormones which suppress our immune system are released and our brain cell's health is compromised. BUT,  remember , the threat response is only short lived and is helpful too , for that particular situation. Other that that , no other stress impacts us negatively.
Infertility is stressful , there is no doubt about it. If you see it as an interesting challenge and tackle it accordingly , the stress of it will only help you and your body to fare better. Believe in your body , it will not let you down. Don't be afraid of the stress , it is only working hard to make you much stronger , courageous and resilient. Don't you know that the coals which withstands high pressure turns out to be precious diamonds ? If you withstand the stress of infertility and infertility treatments ,  you are more likely to give rise to precious babies :)

Monday, June 20, 2016

IVF failure - when emotional pain is stronger than physical pain !

" Thanx a lot manju...i just love to read your reply.
I am very lucky to have a very loving and understanding husband. Just finiahed my 3rd ivf. Same protocol with 450 iu fsh daily for 10 days fron day 2 and cetrotide. Collected 9 eggs. 4 mature and 3 immature, 1 dead. 4 eggs icsied and got 3, 6 celled and 1,8 celled day 3 embryos and 8 cell embyo was grade a with no fragments. and others with small fragments.they tranfred 4 embyos My dr was very hopeful for this cycle. But just got my bfn on day 14. And this cycle also was not succesful. My progestrone on day of hcg administration was 1.7ng/ml. I was reading that elevated progestrone on day of hcg admnstration have a negative impact on implantation. As endometrium is less receptive. I am not finding any comfort anywhere. I am so hopeless. Just want to have my bundle of joy, but it seems its not going to happen.
I feel good talking to you. Just someone with whome i can share everything.
Thanx a lot for being there. "
Dear S ,
" I understand your pain. I have gone through IVF failures many a time - we feel so hopeless , and future might appear very dark and bleak. All I would say is , cry , cry and cry. It will make you feel better. 
Remember , there are women who go through much horrible times due to infertility. I know women whose husbands took it as an opportunity to leave them. I know women who can't get the baby they want because they do not have the necessary money. And , there are women  who just can't have a baby because their ovaries don't work anymore. Being grateful for what we have helps a lot to feel better at these difficult times. It helps you to feel thankful in spite of the sorrow you feel now. Life is never easy , not for anyone. The battles we fight , the courage and strength we show , will define who we are. 
First , even if you do not succeed in having a baby that's not the end of the world. You are already a wonderful mother and your child will come to you in the appropriate time. Never lose hope.
Yes , progesterone rise at the time of hcg administration can make the lining not in sync with the embryos' developmental stage - this might lead to failed implantation. Why didn't you tell your concern to your doctor at that time ? You could have opted for a FET. Nevertheless , past is past. The good thing is , you produce eggs still. When are you planning to start the next cycle ? Can you write to me before starting it , perhaps a month before you start ?
Now , just take your time to recover - read good books ; grow your spirituality ; do something which makes you feel good about yourself. Life will not stay as such forever - nothing lasts longer. This difficult time will come to an end , too.

Find happiness , please ! You can , it's all within yourself. You just need to know how to experience it , enjoy it , in spite of all the troubles. Finding ways to be happy amidst these difficult IVF times can help you to reach your goal with ease . "

IVF failure is no joke. I have seen couples who became suicidal after an IVF failure. The pain can be excruciating - you feel as if  you are sucked out of energy from every cell of your body ; thoughts about future can be very fearful. You feel as if you can never function properly - doing everyday chores can feel like an Himalayan task ; your professional life can have a set back , for that time being.  But the good thing about an IVF failure is , after you cry your heart out , you feel cleansed inside out. For many , IVF failure can open the door to spirituality - they try to analyze their actions ( life ) spiritually - as a result ,  most couples will definitely become better humans. Your preferences in life will change for the better. Your ego gets tamed , and naturally you start to give importance to the most valuable things in life - you will fill yourself with love and gratitude , rather than hatred and fear. After all ,  that is what life is all about ; that's what a failure does to a mature human being. After a painful experience , you will always be left with two choices - to become bitter or better. The good news is , most humans turn out to be better beating the bitterness within them. The only wise words at such times is , " Stay strong , this too will pass "
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