Making sense of your IVF medicines
The superovulation protocol we use for IVF patients depends on two things.One is the patient herself. For example, what her ovarian reserve is , as judged by her age, antral follicle count, AMH level; and her historical response to previous IVF cycles.The second variable is how many follicles we want you to grow. For example, if we want lots of follicles, we use a standard protocol, or an aggressive protocol, so we get lots of follicles . This allows us to collects lots of eggs, and this allows us to form many embryos , which we can then freeze and store.On the other hand, if we don't want too many follicles ( for exa...
Source: Dr.Malpani's Blog - February 23, 2019 Category: Reproduction Medicine Source Type: blogs
Making sense of your IVF medications !
Many patients get confused by all the medicines and injections which are used in an IVF cycle, and this is partly because doctors themselves are very confused.You need to step back and look at the big picture to make sense of the technical minutiae.All we're trying do when we super-ovulate you is to help you to grow lots of mature eggs. We want you a synchronous cohort of follicles, all of which are roughly the same size.In order to do this, we have to give you hormones to stimulate your ovaries, which normally produce only one mature follicle ( which contains only one mature egg) every month. These could be by bumpin...
Source: Dr.Malpani's Blog - February 22, 2019 Category: Reproduction Medicine Source Type: blogs
Embryo pooling for patients with poor ovarian response
Lots of patients who have a poor ovarian response end up getting only one or two embryos in an IVF cycle . Their options are to transfer the fresh embryo in the IVF cycle; or to freeze them, one at a time , store and pool them, and then transfer them later on, one at a time, after thawing them.The reason this is a better option is because time is at a premium for patients with poor ovarian reserve. Transferring an embryo and then waiting to see whether a pregnancy occurs or not ends up consuming a lot of time. It makes more sense to do 3-4 egg collection cycles , back to back , and therefore collect lots of eggs , and...
Source: Dr.Malpani's Blog - February 20, 2019 Category: Reproduction Medicine Source Type: blogs
BRCA Exchange Available on the Web; Understanding BRCA Variants
It's not known among some healthcare consumers that there are a host of BRCA variants other than the standard ones. Normal BRCA testing looks forthree specific genetic variants that are linked to hereditary cancers. Two of these variants — 185delAG and 5382insC — are in the BRCA1 gene. One variant — called 6174delT — is in the BRCA2 gene. A patient may test positive for a variant other than these common ones and it may not be clear under such circumstances what treatment to offer to the patient. The BRCA Exchange is now avai lable on the web that may be of assistance to researchers, physicians, and ...
Source: Lab Soft News - February 13, 2019 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Clinical Lab Industry News Clinical Lab Testing Healthcare Innovations Lab Industry Trends Lab Processes and Procedures Medical Consumerism Medical Research Preventive Medicine Public Health Source Type: blogs
Iatrogenic infertility
Being infertile is bad enough, but when the infertility is caused by an infertility specialist, this makes it much worse !Sadly, we continue to see lots of patients, whose fertility has been damaged because of poor quality treatment.Here is an example ( names withheld to protect the guilty !)I have a very low amh of 1.16. I have undergone 3 cycles of IUI from Dr G, a gynecologist, none of which were successful. After that, I underwent laparoscopic surgery by Dr H, an IVF specialist, for removal of endometriosis cyst. During the procedure , the doctor discovered I had a hydrosalpinx in both my fallopian tubes , so the...
Source: Dr.Malpani's Blog - February 6, 2019 Category: Reproduction Medicine Source Type: blogs
What I Chose to Leave Behind
Books can represent signposts on my spiritual journey. I recently went over our bookshelves because they overflowed with books. They got to that point on account of the generosity of others who wanted to pass on books that we might like to read. I didn ’t want the bookshelves to look so messy so I began a purge. I first asked God to show me which books I no longer needed so that I could bless other people.There were books that had been significant at a particular stage in my spiritual journey. They had assisted me in attaining emotional and spiritual healing after a devastating event that changed the course of my life on...
Source: The Dance of Life - February 5, 2019 Category: Cancer & Oncology Tags: cancer Life experiences My Spiritual Journey Reflections Source Type: blogs
Preserving fertility during cancer treatments
Cancer treatment — and cancer itself — can threaten fertility. This is a tremendously important survivorship issue for many people. As an oncologist, I’m often asked questions about preserving fertility during cancer treatment. If this issue affects you, here is an overview of key options.
When should you talk to your cancer team about fertility?
Future children may not be foremost on your mind when you are diagnosed with cancer. Soon afterward, though, it’s worth talking to your doctor about fertility issues, if this is important to you now or might one day become important.
Your doctor can explain:
the risk that...
Source: Harvard Health Blog - February 4, 2019 Category: Consumer Health News Authors: Ann Partridge, MD, MPH Tags: Cancer Fertility Infertility Source Type: blogs
BioethicsTV (January 21-25): #TheResident #TheGoodDoctor #NewAmsterdam #ChicagoMed
by Craig Klugman, Ph.D.
Jump to The Resident (Season 1; Episode 11): Listening to patients; Jump to The Good Doctor (Season 2: Episode 12): Paying the Piper; Jump to New Amsterdam (Season 1; Episode 12): Impaired Colleagues, Robin Hood docs;Jump to Chicago Med (Season 4; Episode 12): Maternal/Fetal Conflict and Giving Bad News
The Resident (Season 1; Episode 11): Listening to patients
Marisol, a woman in her early 30s, comes to the ED complaining of abdominal pain, with a history of an ectopic pregnancy (lost her right ovary) and a stillbirth after a C-section.… (Source: blog.bioethics.net)
Source: blog.bioethics.net - January 25, 2019 Category: Medical Ethics Authors: Craig Klugman Tags: BioethicsTV Conflict of Interest Featured Posts professional ethics Reproductive Ethics Source Type: blogs
The misdiagnosis of PCO
We see lots of patients who are misdiagnosed as having PCO (polycystic ovarian disease) , and this is partly because lots of sonographers aren't good at making the diagnosis properly.When they see a few ovarian follicles on an ultrasound scan, they interpret these as being small cysts, and any time they see a few cysts in the ovaries, they say that the patient has PCO.This is completely incorrect, because there are very strict criteria laid down for how to make a diagnosis of PCO on an ultrasound scan. The antral follicle count needs to be high; the ovaries need to be large; and the ovarian stroma needs to be increased. Un...
Source: Dr.Malpani's Blog - January 19, 2019 Category: Reproduction Medicine Source Type: blogs
Making difficult decisions - a guide for IVF couples
While most IVF cycles are straight-forward, sometimes we come to a cross-roads when it's not always clear what the next step should be .For example, if have poor ovarian reserve, and have grown only 2 follicles after aggressive superovulation, should you cancel the cycle? Or should you continue?These decisions can be difficult to make, and it's especially when patients find they have to make a difficult decision that they expect their doctors to tell them what to do. After all, doctors are professional experts, and they have the experience and the skills to decide. How can a patient decide for herself ? She has never done ...
Source: Dr.Malpani's Blog - January 10, 2019 Category: Reproduction Medicine Source Type: blogs
Why are pregnancy rates with donor egg IVF so low in India?
Older women with poor ovarian reserve are often told to use donor eggs, because getting eggs from a young, healthy, fertile egg donor will increase their chances of getting pregnant.This makes sense - provided they get a sufficient number of good quality eggs from the egg donor.But the trouble is that most Indian IVF clinics don't have good donor egg programs. They super ovulate fresh egg donors, and then end up splitting these precious eggs amongst lots of recipients, whom they put on a waiting list.This often means that they cannot synchronize the egg collection of the donor with the endometrial receptive of the rec...
Source: Dr.Malpani's Blog - January 4, 2019 Category: Reproduction Medicine Source Type: blogs
The donor egg farce in India
For older women with poor ovarian reserve, donor egg IVF is a great option, because it increases their chance of getting pregnant considerably.The problem is that it's hard to find good quality egg donors - and because response to superovulation is an unpredictable biological variable, often the number of eggs the clinic is able to collect from an egg donor is uncertain.Tragically, lots of clinics continue to use eggs from a fresh egg donor , and this means that often the egg donor doesn't grow many eggs in the treatment cycle, or they're not able to synchronize the cycles of the donor and recipient properly.This means the...
Source: Dr.Malpani's Blog - January 3, 2019 Category: Reproduction Medicine Source Type: blogs
The PCO misdiagnosis epidemic.
There seems to be an epidemic of PCO ( polycystic ovarian disease) today, but I think this is a myth.This is because making the diagnosis has become so easy today - all you need to do is order a "PCO panel of blood tests" from a medical lab. In fact, lots of online portals will allow you to self-diagnose yourself, and order the tests yourself ( through their portal of course, where their preferred partners are happy to give them a kickback for the tests).Also, these labs spend so much money on "creating awareness" about this "disease", that every second teenager has started believing she has PCOD ! Have a little bit of acn...
Source: Dr.Malpani's Blog - January 2, 2019 Category: Reproduction Medicine Source Type: blogs
The IVF Checklist
IVF can seem to be a demanding and complex treatment, which is why it helps if you are well organised !1. Make sure you have completed all your testsWife□ Ovarian reserve testing ( AMH, prolactin, TSH, antral follicle count)□ Infectious disease screen: HIV, Hepatitis, RPR , Rubella□ Vaginal ultrasound scanHusband□ Semen analysisInfectious disease screen: HIV, Hepatitis, RPR/VDRLPlease note how short this list is !Don't waste your money on useless and unnecessary tests such as sperm DNA fragmentation, TB testing, ERA, genetic testing or hysteroscopy !2. Make sure you know how much you have to p...
Source: Dr.Malpani's Blog - January 1, 2019 Category: Reproduction Medicine Source Type: blogs
Fight Aging! Newsletter, December 31st 2018
In conclusion, there are many anti-aging strategies in development, some of which have shown considerable promise for slowing down aging or delaying the onset of age-related diseases. From multiple pre-clinical studies, it appears that upregulation of autophagy through autophagy enhancers, elimination of senescent cells using senolytics, transfusion of plasma from young blood, neurogenesis and BDNF enhancement through specific drugs are promising approaches to sustain normal health during aging and also to postpone age-related diseases. However, these approaches will require critical assessment in clinical trials to determ...
Source: Fight Aging! - December 30, 2018 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
