Why do patients hesitate to change IVF doctors when they are dissatisfied ?

It is common for a patient to experience failures with IVF not just once but several times. In addition, many patients are also dissatisfied with the kind of medical services provided by their clinic of choice. What is astonishing is that nevertheless, they choose to continue with the same clinic.
Many patients are stuck because they do not have any alternatives. For instance, when they are undergoing a government aided treatment procedure, they have to necessarily go to a particular clinic mandated by the government. However, when patients are paying a hefty fee for IVF treatments at private clinic, they do have the option of switching clinics, which, surprisingly, they do no avail of.

Patients may feel they are cheating their chosen doctor by discontinuing with him, even though they may be discontented with him. Some believe that the doctor who has already done one IVF cycle for them might have got considerable insight into their case and thus, may be successful the next time. Many patients simply refuse to consider better clinics either because of their false generalized perception that all IVF clinics offer the same quality of treatment; or due to their reluctance to take the effort to search for a better choice. Their reluctance may stem both from a lack of awareness and lethargy. It is possible that they may not know how and where to look.

Take a deeper look into this issue at http://blog.drmalpani.com/2012/12/why-dont-patients-fire-their-ivf-doctor.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

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 ?

Dr Malpani's guide to the embryo transfer procedure - what every infertile patient needs to know

Infertile patients have many questions that create doubt and misunderstanding when it comes to the embryo transfer procedure.  It is especially when good quality embryos fail to implant after a smooth embryo transfer procedure that patients feel cheated; and complain that the IVF doctor did not provide good medical care.

In this review, I will try to simplify the information and dispel some of these misconceptions.

There are two components to successful embryo transfer.  One is the mechanical procedure of physically placing the embryo back into the uterine cavity which is achieved by inserting an embryo transfer catheter into the uterus through the cervix.  The biological process is that of implantation, but this is not something the doctor can control !

The mechanics of the embryo transfer procedure is fairly straight forward and takes only a few minutes.  The procedure is performed routinely in IVF clinics.  A skillful IVF physician is patient and gentle.  Proper procedure and patience is required to prevent injury to the embryo and the uterus.  A steady hand and gentle, deliberate action is required. 

The simplicity of the procedure can be misleading, however.  Pregnancy rates vary greatly among IVF physicians.  There are documented instances of success rates 3 times higher by some IVF physicians who perform in the same clinic under the same environment as other, less successful co-workers.  We have no clear understanding as to why there is such a marked difference in success rates.  Successful implantation is a quality indicator that should be considered when seeking an IVF physician.  Take the time to search for an experienced physician with a high success rate.

Ultrasound guided transfer is a process that assists the physician with actually visualizing the deposit site of the embryos.  Whether using ultrasound improves implantation with an already successful physician is still controversial and warrants further study.