Dr.Malpani's Blog: Video Guide to PCOS ( Polycystic Ovarian Syndrome)

Dr.Malpani's Blog: Video Guide to PCOS ( Polycystic Ovarian Syndrome)

How to become a good IVF patient ?

If you are told that you need IVF to conceive,you naturally tend to spend a lot of time and energy in finding the best IVF doctor.  This is because you know that finding a good IVF doctor will help you in getting the best treatment possible. You want a good IVF doctor who runs a competent clinic; respects you and your needs; will be intelligent enough to tailor the treatment according to your individual requirements ; and is empathetic enough to provide emotional support during your time of distress.

This is quite reasonable, but are you also willing to put in at least half the effort which you took to find a good doctor in becoming a good IVF patient ? Many of us still naively believe that, once we find a good doctor , our responsibility in our treatment gets over , and the doctor will take care of all our needs.  This is not true; getting the best treatment possible and the ease with which you can go through an IVF treatment rests in your hands too. Just like you expect your doctor to be competent, a knowledgeable patient is a good IVF doctor’s delight ! If you learn to be an ideal patient you can reap the best of your doctor and treatment. An ideal patient makes an IVF doctor’s life much easier. Remember, good patients beget good doctors , and vice versa !

How many of you go to watch a movie without reading its review ? If you are willing to do your homework before watching a movie, isn’t it wise to do your homework when undergoing one of the most important and expensive medical treatments you will need  ? It is your responsibility to understand what your treatment is all about , and how it works.  The internet is a boon for patients who want to learn more and there are many authentic websites and blogs written by IVF specialists and IVF patients which will help you to get reliable information. If you become a well-informed patient, you no longer have to be dependent on your doctor for taking treatment decisions; you can work as an intelligent partner with your doctor. This will increase your confidence levels, protect you from medical fraud ( such as unnecessary tests and unproven treatments !) ; and will also act as a shield to protect you against medical errors. If you are a knowledgeable patient your doctor is much more likely to respect you and treat you well. 

Many patients tend to think that they are not intelligent enough to understand medical science. This is why they are afraid to ask their doctor questions, and prefer to bottle these up, thinking that their questions are stupid. . The truth is that you do not need special talents to understand how your body works - you just need to be curious and ask questions. Never be afraid to ask questions; it is the duty of your doctor to explain in terms which you can understand , and clarify all your doubts. When talking to your doctor , make sure that you ask relevant questions , and this can only be achieved if you have done your homework – don’t expect him to spoonfeed you ! When you understand the science behind your treatment , you will be able to understand what your doctor can do for you , and what he cannot. Having realistic expectations of the treatment process  will protect you from emotional breakdown if the cycle fails; and will also safe-guard your doctor from your unreasonable wrath if the treatment does not give the expected result.

Every patient wants her doctor to remember her as a person. You want him to take special interest in your treatment and work extra hard for your success. This can happen only when you work together with your doctor , and show an intelligent interest in what he is doing for you. You should understand that medical science is a rapidly growing field , and there are many different treatment options. When you remain passive, you put all the responsibility on your doctor and he is forced to decide what is best for you. Even though a good doctor works for your best interests, many a time they are biased too ( sometimes without even being aware of their personal prejudices) . They may end up selecting a cookie cutter , generic treatment plan for you, without customizing it to your special circumstances, because this is easier for your doctor , and saves him valuable time. However, this puts you at a risk of receiving sub-optimal treatment. On the other hand, when you understand the niceties of your treatment , you can delight your doctor with your input and ideas, and he is much more likely to understand your needs better. When you contribute to your treatment decisions in an intelligent way, you are more likely to be able to formulate a treatment plan which suits you best – after all, your doctor is not a mind-reader and does not know what your personal preferences are.

A well-informed patient understands that his doctor works for her best interests. If you are totally clueless about your treatment , you will not be able to appreciate what your doctor does for you. It’s only when you appreciate his technical skills and expertise that you will develop respect for him as a professional . Otherwise, you tend to treat him as a person who works for you only because of the money you pay him . A good doctor-patient relationship is important for a good treatment outcome. Like any relationship, a doctor-patient relationship is also a two-way street and it tends to blossom beautifully only when there is mutual trust and respect. A good patient understands this and is ready to do what he can do to make the relationship beneficial for both.

A good IVF patient is patient! She understands that IVF treatment might need more than few attempts to be successful. She doesn’t get disheartened, suspicious and bitter after a single IVF failure. She tends to value and respect her doctor’s advice and act accordingly.  This will help her to remain resilient and carry on with the treatment until she finds success.

In short a good IVF patient has the following characteristics :

•       She has the passion to learn about her treatment 
•       She actively participates in her treatment decisions
•       She respects her doctor and strives hard to maintain a good doctor-patient relationship
•       She engages the doctor by providing inputs
•       She is patient and does not expect that the only acceptable result is a baby !
•       She allows her doctor to earn her trust and follows his advice

Successful IVF treatment needs not only good doctors , but good patients too ! Once you select a competent doctor , you need to work on making yourself competent. This work will pay rich dividends ! The equation is simple - Good IVF doctor plus Good IVF patient = High chances of IVF success !

This I wrote after Dr. Malpani provided me with an outline of what an IVF doctor will expect from his patients. You can read the full article here : http://www.drmalpani.com/good_ivf_patient.htm

Dr.Malpani's Blog: The Medical Report Jargon Buster at www.medexplain.in

Dr.Malpani's Blog: The Medical Report Jargon Buster at www.medexplain.in

Medical Report Jargon Buster is a free application which will help you to make sense of your medical reports. Are you confused by the acronyms, jargons and medical terms in your reports ? - Please visit www.medexplain.in.

What can I do if my IVF doctor does not show me photos of my embryos? Why is it important to see and get photos of your embryos when undergoing IVF ?

What is an embryo and how it is formed?

We all began our life as a microscopic embryo.  An embryo is formed when a sperm produced by the male enters into the egg (when the sperm fuses with the egg) which is produced by the female. The sperm carries half of the information (genetic information) needed for creating a baby and the egg carries the remaining information. The sperm’s function is to deliver the genetic information it is carrying in the form of chromosomes to the egg so that a new life can be created. When a sperm successfully delivers the information it is carrying to the egg by entering inside it, an embryo is formed. On the first day of its genesis (formation) an embryo is called a zygote. The process which results in the formation of an embryo is called fertilization and when couples copulate (have sex) they provide their sperm and the egg a chance to meet each other ( this event takes place inside the fallopian tube of the female) which might or might not end in successful fertilization. The life of your baby begins the moment when an embryo is formed. All living organisms develop from an embryo. All babies come from an embryo but not all embryos have the potential to develop into babies.  This is the reason for IVF failure – not all embryos transferred into the uterus implant; and not all the embryos which implant in the uterus continue to grow. In humans, the term ‘embryo’ is used to refer to the new life that is created as a result of fertilization upto the end of the eighth week of pregnancy. After this, the embryo is called a fetus.

The above picture is just a dust particle resting in the ear of a needle. This can be used as a pictorial representation of an embryo’s size. You cannot see an embryo with your naked eye. You need a microscope which could magnify the embryo several times to have a closer look at it.

How does an IVF clinic create embryos?

For couples who fail to conceive naturally (in their bedroom) IVF technique comes as a boon.  When couples undergo IVF treatment their eggs and sperms are brought together in a petri dish (a sterile plate) which contains appropriate fluids to nourish them. The sperm and the egg which normally meet each other in a fallopian tube are thus allowed to meet each other in an artificial laboratory environment and this facilitates fertilization which ultimately results in the formation of an embryo. During ICSI treatment a single sperm is picked up and injected into a single egg –you can call it ‘assisted fertilization’ which in turn , leads to the formation of an embryo. The embryo or embryos which are formed in such a manner are transferred into the uterus usually after 3 days or 5 days of fertilization. The transferred embryos , if they are competent enough and all goes well, implant in the uterus and develop into beautiful babies. So the entire work of an IVF clinic revolves around creating embryos which are good enough to be transferred into the uterus.

How does your doctor decide which embryos should be transferred into your uterus?

Many women produce several eggs when their ovaries are stimulated with hormones and a good IVF clinic will be able to successfully fertilize most of your eggs (provided your egg quality is good) using your husband’s sperm.  As a result couples undergoing IVF will end up with many embryos. It is a well-known fact that not all embryos result in a baby. If this is the case , how does your doctor decide which embryos should be transferred into your uterus?  Just imagine a beauty pageant , where your embryos are the contestants , and your IVF doctor or embryologist is the judge of that beauty contest. The beauty contest judge has a set of rules to rank the embryos according to their external appearance (by observing them under a microscope) so that the most beautiful embryos are selected to enter the ‘sanctum sanctorum’ (your uterus) , where they originally belong. The remaining embryos , which occupy the next ranks , are frozen so that they can be transferred back to your uterus if the current IVF cycle fails. If you want to know how embryos are graded during their beauty contest please visit this link.

What does an embryo look like during different stages of development?

You can see how your embryo appears during its different stages of development by following this link.

Will my IVF clinic show me my embryos?

It is the duty of your IVF clinic to show you ‘YOUR EMBRYO’ before they transfer it into your uterus. You pay so much money to create beautiful embryos and it is their duty to display their embryo creating skills!  Watching your embryos under the microscope will be a wonderful experience. You will finally get a feeling that the entire process is so real and worth the effort. It is also also your duty to know the basics of embryo development (how an embryo looks during its different developmental stage) so that you can ask the embryologist some reasonable questions. This will help you to judge the clinics competence in creating good quality embryos. For example, a good quality embryo will have 2 pronuclei on day 1 (after 18h of fertilization), 4 cells on day 2, and 8 cells on day 3. On day 4 the embryo will start to compact, so that the individual cells are no longer discernible . On day 5,  embryo becomes a blastocyst which contains approximately 100 cells.  The individual cells (called blastomeres) which make up the embryo should be equal in size and should be free of fragments or with minimum amount of fragments. If you know this basic information and study the ‘beautiful’ and ‘ugly’ embryo pictures on the internet, you can very well become the beauty pageant judge yourself ! If your embryos don’t look as good as expected, ask the embryologist for an explanation. This will keep them on their toes to do their duty well and will also help you to understand whether everything is going on properly with your treatment! So never compromise on your right to have a look at your embryos. If you ask your IVF clinic to show your embryos and if they are reluctant to do so , then it should raise a red flag in your mind. Your clinic should provide you with an opportunity to view your embryos. You are the customer and they are working for the money you pay for them. If they say that embryology lab should be sterile and hence you are barred from entering inside – as a biologist I find this excuse too lame! Going inside and watching your embryos under the microscope will not harm your embryos or the sterile environment of an embryology lab!

Should my IVF clinic provide me with the picture of my embryos?

Definitely! Your embryo pictures are your property. Imagine, when you become pregnant after the embryo transfer and give birth to your much desired baby, won’t it be nice to show your child how he/she looked as embryo? How many people will get the chance to do it?  Won’t the baby album look better with the embryo picture in it? Isn’t the embryo your prospective baby? How can you let go of such a beautiful memory just because your clinic does not provide you with the embryo picture? OK, forget the emotional part, what will happen if you do not succeed and plan to switch clinics? The embryo pictures you can give your new IVF doctor will help him understand whether your embryo quality is good or not. This will give him information about whether the problem is with your fertility or with your previous clinic’s ability to create good-quality embryo. This can also help him to decide whether he must tweak your ovary stimulation regime used by the previous IVF clinic. Why should you lose such invaluable information? If your IVF clinic says that taking a picture of your embryo can damage the embryo do not believe them! Taking a photo of your embryo will not damage them or compromise your IVF success!

What should I do if my clinic doesn’t show me my embryos or provide me with my embryo photos?

Do not be afraid to fight for your rights. First request them, and then demand them. If your IVF clinic is not yielding to your demands , submit your demand in the form of writing. Patients should take a proactive role in their treatment so that they are treated with care and respect. IVF clinics should keep your best interest in mind (you are the customers and they are serving you! They depend on you for their survival) and not theirs.  Remember, the most important work of an IVF clinic is  to produce good-quality embryos and it is their duty to provide you with proof that they are able to do so.  After transferring the embryos inside your uterus , nothing you do can improve your chance of success , but getting good quality IVF treatment is in your hands.  The field of ART is growing into a huge business and as a patient it is your responsibility to get the best out of it.  Being knowledgeable about IVF treatment will protect you from less than optimal medical care you might receive in the field of ART.

My advice for someone starting their first IVF cycle

Schematic representation of IVF process

1)     Learn !

If you have decided to embark on an IVF cycle, the first thing you must do is to learn about the entire process scientifically. I agree that this may be challenging if you are an arts or commerce graduate,  but please do not underestimate your abilities-  the learning process can be be very interesting ! It’s always a good idea to exercise your grey matter  !  Learning doesn’t mean that you have to read complicated scientific papers – just start with the basics. All our reproductive organs have a name and a particular function. Educate yourself about,  your ovaries, follicles, egg, fallopian tubes, uterus, endometrium, cervix, sperm, embryo etc., and their functions. If you have understood this, half your job is done !  There are many audiovisual resources to help you learn at www.ivfndiacom. Next, you need to learn about the medicines used in the IVF process. Learn their names use the search box on www.drmalpani.com and google to findout more about what they do and their side-effects. . When you understand this basic information , you will start to understand what your doctor is talking about. Many doctors do not have the time or patience to teach the patient all these basic information. The more you know about the IVF process the better you feel in the clinic. Otherwise, when you are poked and prodded , you will end up with a feeling as if you are treated as an experimental animal! The more you feel alienated from what is happening in your body, the more you will hate the process. It is not only embarrassing to lie down with your legs high up in the stirrups ,  when your private parts are being manipulated, it is also scary! The more you know; the better you feel. Knowing will also boost your confidence and you will be able to ask intelligent questions to your doctors and nurses.

In short, try to cultivate a passion for knowing things. You are undergoing a very important process in your life , which is not only costly but also emotionally very demanding. Educating yourself about the process will prepare you to face the twists and turn inherent in an IVF cycle. This will save you from lot of heartaches!

2)     Select a competent IVF clinic

When I say competent clinic, it should have skilled, experienced physicians; compassionate staff; and full-time embryologists. From my experience, I have learned that an empathetic doctor is as important as a skilled physician. You should have a doctor who can hear your concerns and answer your questions with patience. He should have the minimal courtesy of saying or writing a few comforting word if your IVF cycle fails. Emotionally, you depend on your doctor for support during the process. When the process fails, naturally you turn to him/her . I heard from one of my friends that when she informs her doctor about the negative outcome of the cycle, she gets back a mail which asks her to plan for the next IVF cycle. Only when people undergo an IVF cycle will they understand how devastating such an experience can be! If you do not get any reply at all, then it is evenworse . So, find a humane, skilled doctor who owns a competent clinic.

How will I know which clinic is competent enough and which doctor is good? The only way to find this is to use multiple sources of information. The usual way people decide which clinic to select is through the information they get from their neighbours, relatives and friends. Actually, this method is easy and convenient. There will be people who have attended a particular clinic , and if they are successful in their endeavour and have a baby, they will recommend that particular clinic. Internet search is another good option. Most clinics have websites today Many websites are very colourful (with beautiful baby pictures) and attractive; with many positive patient stories. But, neither method is fool-proof. So how will you decide which clinic is best? Here are a few points to ponder:

1)     How experienced are they in the field of ART?

2)     Do they have a full-time embryologist?

3)     How easy is it to approach the doctor?

4)     Do they answer all your questions sincerely and promptly?

5)     Are the staff warm and compassionate?

6)     Are all the facilities (from routine hormone tests to egg collection facility) situated within the clinic? (You obviously do not want to run here and there for every procedure!)

7)     How transparent are they in their functioning?

8)     If they own a website, look for how informative it is , rather than how attractive it is!

This is the basic information you should look for. But, the final proof is in the pudding! Only when you enter a particular clinic and work with them you will be able to judge for yourself. The field of ART is becoming very competitive and this means most clinics are striving hard to give their best in order to survive the competition. This is compelling them to be more patient-centered and patient-friendly, which is very good news for IVF patients!

3)     How will I identify a good IVF doctor?

1)     A good IVF doctor will not promise you a baby but will promise you quality service.

2)     A good IVF doctor should not be like God-always invisible! You must be able to meet him in his clinic, without any mediators in-between!

3)     A good IVF doctor is friendly and easily approachable.

4)     A good IVF doctor knows what he is speaking about. He is knowledgeable!

5)     A good IVF doctor discusses the various treatment options with you before taking any decision. He must treat you as an intelligent partner in the treatment process, rather than an ignorant patient.

6)     A good IVF doctor will be honest and transparent in his approach.

7)     A good IVF doctor will be patient enough to answer all your questions.

8)     A good IVF doctor will not raise your hopes too high , but at the same times builds your confidence!

9)     A good IVF doctor functions keeping your best interest in mind rather than his monetary benefits. He will not order unnecessary tests and insist that you use costly medicines when cheaper alternatives are available

10)  A good IVF doctor will not talk using medical jargon. He should use  simple language so that you can follow what he is talking about.

11)  A good IVF doctor remembers you as a person.

12)  Last but not the least-he should be empathetic, humane and respectful.

4)     Treat the hospital staff with compassion

Always remember this golden rule ‘Treat others as you wanted to be treated’. When you enter the clinic, the first faces you see are the staff. They are the connecting bridge between you and the doctors. Actually, they are the people who take care of your personal needs in the clinic (from providing you with proper medicines, injections etc., to offering a few comforting words and positive stories when you are down!). They work long hours and their work is more hectic than that of a physician. When you enter the clinic , never carry all your anger  pain and frustration with you. Learn to smile and be caring and compassionate. Do not complain about petty things. Even though you pay for the service you get, you can’t make everyone smile and behave compassionately just for money. If you find a chance, get to know them a bit and behave in a way that they treat you with love and affection. Most importantly, learn to say ‘THANK YOU’. I am not asking you to put up an act. Of course, these things should come from within you. When you are friendly with them and if they get comfortable with you, the service you receive from them will be far better. This makes your stay in the clinic pleasant - for you and also for them!

5)     It is OK to be inquisitive!

When your treatment starts, be inquisitive! There are no stupid questions except the ones you did not ask. Asking appropriate questions about your treatment and medicines will help you to acquire knowledge and will also keep the doctors and hospital staff on their toes ( which is good for them as well !) . The more the questions you ask about your treatment, the more careful they will be about what medicines they are giving you and how they treat you . Never take any medicine without asking : what it is, why it is used and what are its side-effects. Remember, there are lots of patients and your physician sees many everyday. There are chances that the staff may confuse your details with another patient. So The involved you are in your treatment, the more protection you get from unintentional errors. The more knowledge you gain, the more questions you will able to ask, and the more attention you will get!

6)     Insist on seeing your embryos

Seeing your embryos created in an IVF lab is a wonderful experience. It makes the whole process appear real and worthwhile! Every good clinic will be ready to show you the embryos. Ask the embryologist to explain the different stages of an embryo and how they look at each stage. You can also learn a lot about embryo development and how they are graded. Looking at your embryos and understanding their quality will help you to learn a lot , and is the best marker for how competent your clinic is in creating good quality embryos!

7)     Demand your medical records

I did not say you should ask for your medical records or request your medical records – demand them! Your medical records are your property. They carry all the vital information about your IVF cycle. If you decide to switch clinics, the information you carry with you in the form of medical record will save you from repeating many expensive tests. It will also give your present doctor a clue about the further course of action. A good clinic, acting in a transparent manner will provide you with your medical record without asking for it. If they do not provide this, then you have a legal right to demand a copy !  If you make this request in writing, no clinic will dare to ignore this.

8)     Be cautiously optimistic

You have crossed the various stages of treatment involved in an IVF cycle and your embryos have been transferred into your uterus – what next ? What should you expect?

The 2ww is the most draining phase of an IVF cycle. You will be excited and at the same time fearful of the outcome. The people around you will start treating you like a pregnant woman. You will be happy and at the same time you will be unsure how to react? You know that you can’t be pregnant until the embryos attach and start producing HCG. When you tell them the fact they will look at you very seriously and say ‘BE POSITIVE’. You wonder within yourself what it means to be positive - ‘Should I decide that I am pregnant?’ Your husband wants you to be careful all the time and will not allow you to do anything which will make you feel normal. Your doctor will say bed rest doesn’t matter. Your friends will ask you to eat pineapple core to make the embryo stick! Your mother-in-law will ask you to avoid all the heat generating foods (whatever it is!). Your mother will be praying to all the Gods in the world and she will be insisting that you pray too! You will for sure be confused. You do not know how to calm their excitement. Even the simple question, ‘How are you ? ’ triggers frustration within you. People do not realise that they are instilling lots of fears in you and putting all the responsibility on you by their kind actions. They want you not to think about the embryo transfer and be stress free, but each and every action of theirs will remind you of your prescious embryos within you. You worry what will happen to their expectations if the cycle doesn’t work and how you will be able to face them if the result is negative . You will be also wondering about your embryos-what are they doing inside me? You suddenly become aware of your body all the time, you will be sensitive enough to note even the minute changes that happen. Every pain, every cramp will make you wonder whether it is a pregnancy symptom. When you read about early pregnancy symptoms on the internet , you feel that you have all of them - or you will get all of them the next day itself (your mind is so strong, it has enormous control on your body!). It is hard, very hard!

The only wise advise I can give you is – Be cautiously optimistic! IVF is a process which has its own limitations. There is only 40% chance of success if you are below 35 years. So, theoretically the chance of failure is more than the chance of success! Not every embryo transfer will result in a pregnancy. But there are also woman who succeed in their first attempt! Try to have a realistic expectation. Even before starting a cycle prepare yourself to undergo at least 3 IVF cycles. This is the average number of cycle most women will undergo before finding success. It is very natural to expect things to turn out for the best but in an IVF cycle there can be many unexpected twist and turns that could stop things from happening as you expected. There is a lot of uncertainty involved because we are dealing with a biological system. If you are fully aware of this, you will learn to expect the best and prepare yourself for the worst! Being blindly positive will not help you and for sure will not help your embryo to stick. Being too positive might break you into pieces if the cycle fails and will cause you to carry a grudge about everyone and everything involved in your IVF cycle. If you want to protect your sanity; learn to expect the unexpected!

9)     Be kind to your physician

A good physician has your best interest in his mind and works for you. A doctor is a human too and he expects proper recognition for the work he does. I do not know how many people take time to say thank you and appreciate a doctor’s work when the cycle succeeds. But the first person whom most people blame when an IVF cycle fails is their doctor! It is human nature to blame someone or something else for their failure. The blaming nature becomes worse when the person is naive about the IVF process. ‘My friend did her IVF cycle in another clinic, she is pregnant now. Since I did not get pregnant it should be the fault of the clinic’. This appears to be a logical argument when people do not understand the limitations of a biological process. The more ignorant they are, the more likely you are to carry grudge about your doctor for the failure. Remember, you selected the clinic and you are going through the entire process by choice . When you are not satisfied with the quality of service you receive, you should talk to the doctor then and there and solve the problem. A good doctor, like a good teacher, will address all your concerns and try to clear all your doubts , whether they are logical or not. If you do not clarify your doubts and carry them with you all the time, they will be magnified 1000 times if your cycle fails.Whether your doubt is logical or not depends on how knowledgeable you are about the IVF process.

Another reason to hate and blame a doctorwhen your cycle fails is the huge amount of money you have spent on the process. Today, a doctor-patient relationship is solely materialistic. The patient sees doctor as a businessman who is waiting to grab all his money. A doctor just sees a patient as his source of income. Trust is the main ingredient which is necessary for a good doctor-patient relationship and in today’s materialistic world , it is completely lacking! Only when you trust your doctor will you feel good while working with him, especially, when doing IVF. We must accept the fact thata doctor will charge for the knowledge he has , and for the services he provides. Does anyone of us work for free ? Will anyone of us compromise on our salary? It is not wise to see a doctoras a personwho works just for the money you provide.  Be kind to them and appreciate their work! Respect them as you would like to be respected. A doctor travels with you through your IVF journey. He will be happy when you succeed and when you fail to conceive , it is his failure too! Be kind to your doctor when the cycle fails. Do not allow money to play the spoil game. After all, your attitude will often determine whether a doctor works just for what he is paid , or whether he is ready to go the extra mile for you! A good relationship with your doctor will make you feel as if you are cared for in your mother’s home , and not like in your mother-in-law’s place ; )

10)  My IVF cycle failed - should I change the IVF clinic?

If you are comfortable in your present clinic; if you are satisfied with their service; if you trust your doctors and their expertise; then I would say it is not advisable to change a clinic after a single failed cycle. Your doctor needs time to study how your body reacts to the drug. He may design a better stimulation protocol the next time around ; or he may have a better idea which will improve your chances of success . Remember that your doctor has limited powers . Even if a cycle goes perfectly,  he has no control over what happens inside your body. So, be patient! There is no guarantee that you will end up getting pregnant in a new clinic. But, if you could find a clinic which boasts of a 60% success rate (like CCRM in USA) instead of a 40% success rate in your present clinic, then I would definitely give it a second thought.

11)  When should I give up the IVF process?

If you are someone who is blessed with all that you need for doing an IVF cycle, never give up! That would be my personal advice. But there are many factors which could decide how many IVF cycles you can go through before you taste success , or before you decide to quit. Financial status, your ability to bear stress, your relationship with your partner etc., are some of the most important factors which will determine how many IVF cycles you can go through. I would say stop the process when both your heart and mind says enough! I sincerely wish every woman going through this process finds success as quickly as possible, so that they never have to think about quitting. It is wise to have a back-up plan so that you know what to do when IVF doesn’t work!