Games the mind plays during an IVF pregnancy

This is a guest post from an expert patient, who is pregnant

Dear Dr Malpani,

Today was not a great day- Its 7w2d right now, and I oscillate so much between fantastic days and horrible ones that these remaining 7 months are going to be hard. I see it, I feel it. I place too much weight on my illogical symptoms and I need to let go of that. I have ‘zero’ nausea. I started with hunger pangs and some stretching and aching in the general uterus area and increased frequency of peeing and it’s all dying down. The only thing consistent are my heavy breasts- and I’m taking external progesterone, so I don’t know what to credit them to.

I wake up at night in a sweat, wondering of my baby is still fluttering… worry if it’s growing and as I lie awake at night for a bit- then I just drink water, urinate and try to fall back asleep. I panic in the day if I forget to think about my baby for over an hour. I dream about holding her, then feel guilty for dreaming. I look up baby names, then abruptly shut the browser window. I just wish I didn’t know that I was pregnant- because if I didn’t, all these symptoms that I feel or don’t feel would just be chalked up to nothing. I wish I could go back to the innocent days of not knowing what could go wrong. I wish I could get my faith back right now- because today it’s giving me a very tough time.

I am not complaining - I know that complaints don't help, and that I have a lot to be grateful for. Still, I wish there was a way I could fast forward time !

And if I get through my 8 week appointment with a beautiful ultrasound and a strong beating heart and perfect size baby and sac, I will remind myself with this post that my symptoms- actual or lack thereof mean nothing. I have to enjoy what there is to enjoy and suffer what there is to suffer. Treat both joy and suffering as part of life and keep praying every single day.

As an IVF doctor, all I can do empathise and pray ! I know the waiting is hard - and even after 25 years as an IVF specialist, there's still so much suspense and anticipation while we wait for our patient's HCG reports and pregnancy scan updates.

Why IVF patients need to complain if they are unhappy

IVF treatment does not always go well, and many IVF patients may have complaints about the way they were treated.

However, if you have complaints about your treatment, or want to complain about a particular staff member of the IVF clinic, you are scared to do so, as you feel this confrontation will aggravate your stress. This is why a lot of complaints get bottled up, and patients are reluctant to provide feedback which can help the IVF clinic to improve.

The best way to solve a problem is to do it face to face, right when the problem is occurring, or soon after  State your concerns, needs, and expectations clearly.

• If you have a concern, you should immediately speak up. At a small clinic, you can talk to the doctor directly. A lot of patients are scared to do so, because they feel the doctor is "too busy". However, the job of a good doctor is to take care of patients, and no doctor is so busy that he can afford to neglect his patients. After all, patients come first, and you should focus on making sure you get good care. If you are taking treatment is in a large hospital, you may need to talk to the IVF Clinic Manager or the CEO.
• A lot of patients are scared that the staff will get irritated with them if they complain. However, don't think that the doctor will get angry if you complain. Complaining will not cause your care to be compromised. Good IVF clinics want to help you resolve your problem as quickly as possible. This is in your best interests, and theirs as well. After all, no good IVF clinics wants unhappy patients !
• You should be clear about your own expectations. What do you want? What do you expect the clinic to do? This allows the IVF clinic to know what will help. Please remember that your responsibility does not stop when you identify the problem - a constructive complaint also identifies a solution !
• If the doctor is not accessible, you can always send him your concerns in writing - perhaps by email or as a letter. Written complaints are always taken more seriously.
• It is usually best to resolve problems through face-to-face conversations. These can result in better and faster understanding.
• A good IVF clinic will use your experience to further improve their quality of care. 

At Malpani Infertility Clinic, we take patient complaints very seriously, as they are an opportunity for us to improve. Not only do we have a  have a Patient Complaints and Compliments book, we encourage patients to email me directly, so I can help to resolve their complaints .

Managing patient complaints - Dr Malpani's guide for IVF specialists

The best way to manage complaints is to prevent them. This is why patient education becomes so important.


The trouble is that IVF doctors are very busy, and don't have time to sit and talk to their patients.



Also, for the first consultation, the IVF specialist is usually in "sell mode" and is trying to do his best to convince the infertile couple is that he is the best IVF doctor in town and that they should come to him for their IVF treatment.

He is very likely to overpromise - and fill the patient with lots of false hope, based on sweet talking them, or quoting highly inflated success rates.


While it's easy to fool gullible patients, it's not possible to fool all the patients all the time, and this kind of behaviour is very short-sighted because it comes back to haunt the doctor when the IVF cycle fails.

Patients feel cheated , and feel the IVF failure was a result of the doctor's negligence or incompetence. Even worse, lots of doctors refuse to see patients when the cycle fails. Because the doctor is too busy doing consultations for new patients, the old patients are fobbed off and handed over to an assistant or a nurse. Patients feel abandoned and are angry and vengeful.


It's important that patients have realistic expectations of IVF treatment - they need to understand that the outcome of an IVF cycle is always uncertain and not in anyone's control. If this is explained before the cycle starts, patients are much better able to come to terms with IVF failure, and are much less likely to complain unnecessarily.



This is why doctors need to be proactive, and educate patients, either using books to do so; or with the help or nurses, assistants and counsellors.


We use our IVF Comic book ( which you can download free); and the free IVF e-learning course at www.ivfindia.com to ensure that patients have realistic expectations of our treatment. The fact that we are willing to discuss failure openly actually helps mature IVF patients to increase their trust in us.

Have complaints about your IVF doctor ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !

The Commonest IVF Patients’ Complaints About Their Doctors

There is no patient who cannot recount horror stories about doctors. If you ever reveal yourself to be a doctor at a random party, be prepared to be regaled with endless complaints as to how terribly insensitive and uncaring doctors are these days. Apparently, their legendary family doctor was far superior  and everyone fondly remembers the caring doctor of yore, who made house calls and was a friend, philosopher and guide along with being a doctor !

That doctors do not share information with them is by far one of the most common complaints. This is a rightful complaint as doctors, being busy, do not share information with their patients unless they feel that the patient needs it. If the patient’s health is improving they feel that it is useless to burden them with information about their pathophysiology and differential diagnosis. But if the patient doesn’t get better, they will most likely have complaints against the doctor for not sharing all information with them. Assuming that he deliberately withheld information they imagine that the doctor is simply out to cheat them. But the fact is, he may simply have been too busy to reveal information to them.

It is a waste to make complaints that your doctor does not share information with you. You only become sulky, enraged, sad and bitter with your doctor being none the wiser about your resentment. Your doctor most probably thinks he has told you whatever you need to know.

Learning productive strategies to work as active partners instead of being passive recipients of treatment can be a wiser approach for patients. It is best to turn confrontational with the doctor only if the output is bad. Patients need to learn to be more assertive instead of being inert.

If you want more light shed on what information you need to maximize your chances of IVF success, please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Why are IVF Patients scared of Complaining About Doctors

A doctor couple who had had failed IVF treatment at another clinic came to Malpani Clinic. The ophthalmologist husband and the dermatologist wife had undergone two IVF cycles in a leading Mumbai hospital. When I asked him for notes and photos of the embryos from their previous IVF treatment, they confessed to having none. This was a setback for me because I could create a treatment plan more easily if I had known what the other doctor had done. The documentation would have served as a template which I could wisely modify according to the patient’s individual response,  to facilitate her to grow eggs of better quality and to improve her chances of pregnancy. With such valuable information unavailable, I was forced to start all over again with just my speculation to aid me.

Despite being a doctor himself, the patient became defensive when I asked them for these details. They said that this hospital didn’t have the norm of providing documentation. I explained to them that a discharge summary, operative note and relevant photographs are always provided to the patient every time a medical procedure is done. I expressed surprise at the fact that despite both of them being doctors, they didn’t even insist on getting the basic paperwork for their IVF treatment. Discomfiture visible on their faces, they revealed that they had assumed that this was the way it worked in Mumbai! I got to know that they had been told to pay in cash by their doctor and hospital and had not received any receipts for the same as well ! Presuming this to be the usual norm, they hadn’t bothered to ask any questions. 

Is your IVF doctor hiding information from you ? If you need more light, please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Is It Right for IVF Patients to Make Complaints Against Their Doctor when their cycle fails ?

All doctors wish to see their patients get better. Rightly so, because helping and healing others is one of main motivations for someone to become a doctor in the first place. Doctors have chosen a profession which is the pinnacle of service provision. Doctors have a direct personal relationship with their patients. The best doctors invest plenty of time and energy for their patients’ happiness.

Even business-wise this is the right thing to do. Satisfied patients offer good reviews about the doctor, which become attractants for new patients.  Doctors are well aware of this strategy which is the best form of marketing for the medical profession. Therefore, if the patients are happy , so are their doctors.

Sadly, not all patients respond well to IVF treatment. Sometimes medication may not work or the body may not respond properly to treatment. In IVF treatment, a major chunk of the outcome is beyond the doctor’s control. Even the best doctor can only make the embryos in the IVF lab and then transfer them into the uterus. What happens thereafter is out of the doctor’s hands. Unfortunately, a major portion of embryos do not become babies. It implies that the chances for the success of a single IVF cycle are less than the chances for failure.

This harsh truth is irrefutable. So we put in our best efforts at educating our patients at Malpani Clinic and preparing them for all eventualities.  We are frank with our patients and show patients photographs of their embryos even when the odds are not in their favor. We encourage patients to get as well informed as possible , so that they may expect realistic results out of our efforts.

Patients are visibly depressed when an IVF cycle fails, and even though they may appreciate our sincere endeavor. . When an IVF cycle fails, rather than complain, a smart patient must analyze the failed cycle with their doctor. 

Need help in analysing your failed IVF cycle ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Dr. Malpani Addresses Patients’ Complaints

Malpani Clinic puts in its best efforts to provide high quality medical care to all patients. However, there are still several unhappy patients who have many complaints about us. We strive to address these complaints the best way we can. There are mostly three kinds of complaints about Malpani Clinic.

Firstly, patients feel that the services offered by Malpani Clinic are way too costly. Expensiveness, as a parameter is hard to measure. Compared to other IVF clinics in India, Malpani Clinic is indeed costlier. However, reviews of the costs of the IVF clinics in the UK and the USA make it clear that the rates offered at Malpani Clinic are significantly more affordable. This rate is justified by our higher rates of success with IVF and a more personalized care when pitted against other IVF clinics. Patients usually shirk from spending a lot on medical care. Thus, when they go for IVF treatment, the prices come to them as a shock. But Malpani Clinic has published all the rates in the website and we are quite straightforward about our costs. Patients who have this information before approaching us have no reasons for surprise and therefore no reasons for complaints.

Secondly, patients are disgruntled that I am too frank and honest with them which hurts their feelings. This is true again as I don’t believe that I should cheat patients with pleasant sounding words when the truth is that they have a bad prognosis. I explain things to them as honestly as I can. Telling patients what they want to hear instead of what is the truth serves no practical purpose. It only fosters false hopes in the patient’s mind. Learning about the truth as soon as possible, helps them find a solution for their problems in time. 

Read more about the third complaint about Dr. Malpani at http://blog.drmalpani.com/2012/10/patient-complaints-about-dr-malpani.html

When IVF doctors err

Being human, it is inevitable that IVF doctors also make mistakes. I made a mistake too, not long back. While consulting a new patient at Malpani Clinic recently, I accidentally put down her age as 41 instead of 31. The problem was that owing to my miscalculation, I had put her in a category beyond the crucial age of 35. Since, age is a major determinant for infertility treatment, I advised her to consider IVF treatment.

At the end of the consultation. I have the habit of making reviews of my own advice and records with my patients to ensure that they have completely understood what I have to say. With this patient, I started off by saying, “Given the fact that you are 41, I think you need IVF”. I was interrupted by her with the embarrassing revelation that her age was only 31 and not 41! I was highly mortified with this very basic mistake of mine , and I quickly apologized. I made corrections and consulted her afresh after reviewing my advice. Needless to say, the patient was visibly upset with this episode and very understandably so. For someone who wasn’t that weak in making simple mathematical calculations, it was a shameful mistake. The patient might very well have felt that an error in doing something as simple as calculating her age could reflect my incompetence as a doctor.  She might even speculate as to what other mistakes I might make in the future. Chances are, she might decide against coming to me for treatment.

Then again, when I encounter mistakes made by other professionals, I am open towards viewing things from a more lenient perspective. I am willing to be forgiving of them because I have made y own share of errors. 

Do you think your IVF doctor has erred in your treatment ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !