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Many IVF doctors in India travel extensively. They have many clinics all over the city ( and in some cases, all over the country). Naive patients get impressed by such doctors - wow - he is so busy and so much in demand that he needs to travel all over the place. In fact, some doctors even go to Dubai and Africa ! While this seems very impressive, in reality this means that the quality of care they provide to their patients leaves a lot to be desired. Let me explain.

The personal goal for these doctors seems to be to maximise the number of patients they treat, so they can maximise their throughput and their revenue. While it's very good for an IVF clinic to be busy, it's also important that the quality of care provided to their patients not be compromised in the quest for quantity !

How do these doctors manage to do IVF in so many locations ? They usually do so by batching groups of patients together, so they treat lots of patients within 1-2 days. After they finish one batch of patients at one site , they then move on to the next site ! While it's medically quite feasible to program IVF cycles, the truth is that ensuring that all patients grow eggs at exactly the same time so that they will all mature on the same day for egg retrieval is simply not possible. The doctor is forced to cut corners for some patients because he's trying to force a square peg into a round hole - and this is especially harmful for older patients ( with poor ovarian reserve); challenging patients ( who have failed many IVF cycles in the past) ; or patients with PCOD ( who may end up hyperstimulating), because it's not possible to individualise their superovulation protocol. Such a rigid travel schedule means the doctor cannot afford to be flexible or cater properly to the "outliers".

So what happens to these patients ? They fail to get pregnant - and unfortunately they are not sophisticated enough to realise that the failure is not because there is a problem with them, but rather because they are not good candidates for "programmed" IVF ! They need a more focussed clinic which can spend the time and energy needed to optimise their chances. However, doctors who are focussed on the bottom line are really not very interested in treating these challenging patients. They would rather treat lots of young patients and improve their turnover, rather than take pride in getting the difficult patients pregnant !

The other major problem with this kind of itinerant IVF is that it's not possible to develop a relationship with your IVF doctor. In fact, you may not even see the IVF specialist for more than a few minutes, because this "big-shot, big-name" doctor may just breeze in, do the embryo transfer, and then breeze out ! If you have questions, you will never know whom to get the answers from, because all the juniors are uncoordinated and cannot make decisions, because they do not have the expertise or the experience to do so !

Now there's nothing wrong with this McDonald approach - after all, it seems to work well for these doctors ! This is because in each batch, the young patients who are good ovarian responders , will get pregnant ( though the success rate will not be as high as it could be in a full-service IVF clinic). But this approach is obviously not right for all patients ! If you've failed an IVF cycle; or have poor ovarian reserve; or need TESE or have PCOD, then you should rather select a clinic which provides all its services all the time in one location !

This is why all the world's leading IVF clinic all operate from a single location. They understand that IVF is a very labour intensive process, which needs close monitoring and extensive tweaking to optimise outcomes for their patients. Good doctors would rather focus on each individual patient, and are confident that if they are good, patients will come to them, rather that their having to go to other cities to find more patients to treat !

If you need a second IVF cycle, and if your IVF doctor is not present in the clinic all the time, you should be very worried about the quality of the care you will get ! If you want to maximise your chances of getting pregnant, send me your medical details by filling in the free second opinion form at www.drmalpani.com/malpaniform.htm and I'll be happy to help !

We treat patients from all over the world and many of them want to do a phone consultation with me before coming to our clinic for an IVF treatment.

I can understand why they want to do so - after all, going half way across the world to get treated by a doctor you've never seen or met is a major leap of faith - and talking to the doctor can help to reduce some of this anxiety !

While it's true that the human touch is very important in providing good medical care, the truth is that it's not humanly possible for me to do so. This is true for many reasons.

For one, because of time zone differences, it's quite difficult to find a time slot which suits both the patient and me. We often end up playing phone tag - causing even more frustration ! Also, phone connections in certain countries ( such as Africa) are not of good quality, so that it's hard to hear each other. Also, sometimes patients forget some of their questions ( not all of them are well organised enough to prepare a list of their questions) , which means they often need to call twice or thrice ! Also, sometimes they do not understand what I am saying , because I may use a medical term they are not familiar with and it can be hard to explain everything in detail on a phone call . Another problem is that the husband calls me ; and after I finish answering his queries , his wife calls in another 5 minutes for additional clarifications, because he could not explain to her what I told him ! And when I am busy seeing patients in the clinic , it's hard for me to spend time on the phone . This means that my phone conversations are often short , which gives patients the wrong idea that I am curt or rude !

However, my major argument against a phone consultation is that it is not a very efficient means of communication ! There is no documentation , and too much scope for confusion and errors. This is why I prefer email, where everything is written down. I can answer as many questions as the patient has - and the patient can share this information with friends or family members who are doctors or nurses , to make sure I am providing sensible advise. They can also cc their spouse, to make sure everyone is on the same page. Because we can store and refer later on to this email conversation trail, there is no scope for ambiguity; and no confusion about medications or their dosages .

It's also much easier for me to answer more complex questions in case more clarity is needed, because the patient can ask for more details in his reply, in case he does not understand something I have said. Moreover, the advise I can provide by email is far more sophisticated and reliable as compared to a phone call, because I can think carefully before sending the email ! Email also allows the patient to send me all their medical records, so I have all the medical details I need to provide intelligent answers , customised to the patient's medical history !

A major benefit with email is that I can provide links to the relevant pages on our website, so they can get even more detailed information about their specific problem. While some patients email is much more impersonal than a phone call, I believe email is much more efficient, when used intelligently !

This is why I request patients who want to talk to me to send me their medical details by filling in the free second opinion form instead, so I can guide them properly. Some get upset with me because I refuse to talk to them on the phone - while others understand that I am doing so in

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