Why IVF doctors and IVF patients need to talk !

Part of a physician’s education is learning therapeutic communication techniques for conversing with their patients and staff, but there is always a “human component” involved in communication.  A physician is responsible for the well being of many patients and sometimes that can wear on his patience, but patients also have the responsibility of being able to communicate in an effective manner. 

The key to effective communication on both sides of the proverbial fence is respect.  Consider how you would like for someone to talk to you.  Be patient and understanding if there seems to be a breakdown in communication efforts.  Be the first to apologize even if you feel it wasn’t your fault.  Most heated conversations start with a misunderstanding.  If you are unclear about something, ask questions until you understand and try not to take your frustration out on your physician. 

Realize that you may only have one physician but he may have hundreds of patients he needs to respond to.  Allow an appropriate amount of time for him to get back to you without getting upset.  Be pleasant when you respond and think before you speak.  If you can’t think of anything nice to say, it’s usually best not to say anything at all.  Learning basic tools of communication will reduce complaints in the patient/physician relationship.  Don’t cheat yourself out of an effective medical alliance, but try to be cooperative.   

For further reading take a look at this page in Dr. Malpani’s blog, http://blog.drmalpani.com/2005/02/improving-doctor-patient-communcation.html

When IVF doctors differ

Medicine is not an exact science and there frequently are several options available for treating one health problem.  It is not uncommon for patients to get confused when they are offered very different medical opinions for the same condition.  Do not let this become an issue of distrust between you and your physician - this can end up becoming a foundation of dissatisfaction and patient complaints.   

Evidence based medicine is a popular form of practice, especially since it is driven by insurance reimbursement.  Medical practise today is dictated by insurance companies , who pay for the treatments, and this has sadly become more of a business than a science in the past 50 years.  A physician learns a lot of information while in medical  school but this is only the basic foundation of a good doctor’s knowledge.  A good IVF doctor then builds on this knowledge as he practices medicine.  He learns to apply that knowledge which in turn builds his level of expertise.  This application of theoretical knowledge in the clinical setting is an art and is impacted by the expertise of the physician. 

The doctor’s individual philosophy of practice also affects his treatment modality.  Some physicians like to consider themselves progressive and will join any current trend that comes along.  I consider myself to be very conservative.  I will discuss all treatment options available to you when the time is right.  I believe the goal of a successful doctor/patient relationship is to be sure that you and your doctor have similar philosophies, especially when it comes to treatments such as IVF. 

For additional reading see http://blog.drmalpani.com/2005/02/why-do-different-doctors-have.html

Can an IVF doctor cure my infertility?

Most diseases are addressed by diagnosing the cause of the disease and then treating the underlying health issue . That is the standard practice for most medical physicians.  Determining the diagnosis is the beginning of finding a cure or correcting the underlying problem.  In the field of infertility, this can lead to frustration and complaints by the infertile couple because the treatment modality is a little different.  Unlike other health issues, infertility frequently cannot be cured.  That’s why at Malpani Infertility Clinic, we frequently suggest IVF as an alternative to infertility. 

Here’s an example.  If a man has a low sperm count, the expectation would be that the physician will do a diagnostic work up to determine the cause.  The physician then reviews all of the test results.  Once a definitive diagnosis is made, the physician would then initiate treatment to correct the underlying problem that causes the low sperm count.  Treatment could be surgical intervention or medication depending on the diagnosis. While this is a logical approach, the tragedy is that it does not work well in real life, because we do not know the cause of a low sperm count in most men, which means we cannot treat the problem effectively ! This frustrates patients, who complain that doctors are useless. Many infertile men feel cheated because they have wasted so much time and money on ineffective treatments.

The good news is that treatment for infertility is success driven rather than problem or diagnosis driven.  At Malpani Infertility Clinic the goal is success in giving you a baby ! Instead of focusing on the cause, we often can provide a solution through bypassing the problem. IVF is recommended because IVF technology has provided us with the capabilities of achieving a pregnancy , even when we do not know the cause !

For additional information see http://blog.drmalpani.com/2012/03/we-want-doctor-who-will-treat-cause-of.html

Anti Mullerian Hormone: What’s the Story?

Infertility in older women can now be evaluated by assessing the AMH; that is the anti-mullerian hormone, also known as MIS or Mullerian inhibiting substance.  The AMH level in the blood is a quantitative indicator that allows us to measure egg quality and egg quantity.  In other words, it gives us a look at your ovarian reserve.  This hormone is produced in granulosa cells in the ovarian follicles. With a good ovarian reserve, the AMH level should remain consistently high as antral follicles are plentiful.

Before AMH testing was available , we used to depend on checking FSH (follicle stimulating hormone) levels.  High FSH levels were indicative of poor ovarian reserve.  However, because of the fluctuation of FSH levels with the day of your cycle, these levels were not always dependable.  FSH levels can also be artificially suppressed by high estrogen levels.  AMH is a much better indicator of ovarian reserve.  It remains constant throughout the cycle and is not affected by estrogen levels.

Should your AMH level turn out to be low, don’t panic.  Low AMH levels do correlate with lower IVF success rates, but, it’s not the test , but the patient we treat here at Malpani Infertility Clinic !

For additional information see I have a low AMH level - what should do I do ?

Why follicular studies can be a waste of time

Follicular study ( also known as ovulation tracking ) is frequently the first test which many gynecologists advise for their infertile patients.  At first glance, this would make sense.  The process involves a series of vaginal ultrasound scans which will determine your precise ovulation time.  You then must engage in sexual intercourse at just the right time, the objective being to match the sperm with a ripe egg that will be fertilized.  Pregnancy occurs and the baby arrives several months later!  This seems like a failsafe solution if you are young and all your test results are normal.

Unfortunately, this is not the case and many patients have unrealistic expectations of follicular tracking.  The success rate of this practice is only about 10% in healthy women with perfect cycles.  Human reproduction is not very efficient and timing intercourse is probably not the solution if fertility is questionable.  Couples struggling with fertility are already stressed.

Gynecologists frequently forget the downside of follicular studies.  Taking the time from a work schedule or home life to have the ultrasounds done can create stress for the prospective parents.  What’s even worse is the emotional stress and loss of spontaneity during sex.  This can be deterring to even the most healthy sex life.  While women become focused on the exact time of ovulation and the need for perfectly timed  intercourse, men feel like all the fun has been taken out of one of their favorite pastimes.  This “baby lust” can negatively impact the emotional and sexual relationship between the couple and cause marital discord. Men begin to feel they are taking a backseat to the process of conception.  Male complaints include feelings of being sexually diminished and feeling like they are only being used as a sperm donor.  

Dr. Malpani does not want any of his infertile patients to feel this way.  Do not cheat yourself out of happiness just to have a baby ! 

Please read Why follicular studies ( ovulation tracking ) can be a waste of time