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" What can I do to improve my chances of success ? " As an IVF specialist, this is the commonest question patients ask me.

The following are the 5 key ingredients which you can contribute to the success of your IVF cycle.

1. Faith and trust. It's important that you be able to trust your doctor. Not only should you be confident about your doctor's technical competence, you should also feel secure that he cares for you; respects your desires; listens to your fears and worries; and will be available to give you a shoulder to cry on when you need this . Make sure your chemistry with your doctor is good. Does your doctor encourage you to ask questions ? Takes time to clear your doubts ? This is a tall list, and most doctors are human , so they are likely to fall short. However, in a good clinic, the IVF team should be able to bolster your confidence that you are in good hands.

Remember that your doctor needs to earn your trust . Don't give it away easily ! " Trust - but verify " should be your philosophy !

2. Smiles. Being optimistic helps to improve success rates. It's not that pessimistic patients don't get pregnant - it's just that patients who smile get better care from the medical team - and everything you can do to improve your odds is worth doing !

3. Being well informed ! Do your homework, so you have realistic expectations from your treatment. Ask questions and take a guided tour of the facility. Request your doctor to show your follicles on each scan - and ask to see photos of your embryos. Well informed patients get better medical care because they ask intelligent questions. Insist on a medical treatment summary at the end of the IVF clinic - this is valuable documentation and keeps everyone's interests aligned . Poor documentation suggests you have received poor medical care !

4. Money. It's true that IVF treatment can be expensive, and you need to be prepared for this. Selecting an IVF clinic which offers a shared risk/ refund program can help you reduce your
risk !

5. Good eggs, good sperm and a good uterus. I know this is asking for a lot, but patients who have good protoplasm have a much better chance of success. It's true that if you are 43, there's little you may be able to do to turn back the biological clock. However, simple self-help measures can make a world of a difference ! Stop smoking; make sure you are fit and have a healthy diet; and take supplements to help optimise your egg and sperm quality. Every little bit helps !

If your eggs and sperm are just not up to the mark, keeping an open mind and exploring the possibility of using third part reproduction can help you achieve your goal of having your baby.

The outcome for any IVF cycle is always uncertain - but taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

Many infertile couples are very confused about how their treatment. Unfortunately, many gynecologists add to their confusion. Thus, if an infertile woman is found to have endometriosis, they will spend a lot of time, money and energy on "treating " the endometriosis with medicines. Similarly, the woman has irregular periods, they will concentrate on trying to "regularise the cycle" !

Why are these approaches flawed ?

The truth is that we really do not have any effective treatment for endometriosis. This is hardly surprising, when you consider that we do not even know what causes this enigmatic disease ! While we are very good at suppressing this medically ( with GnRH analogs), this suppression is only temporary. Even worse, while these medicines are very effective as suppressing the endometriosis , they also suppress normal fertility ( because they stop ovulation). This medical treatment just wastes time and money ; and patients get fed up and lose confidence in doctors and in themselves !

What about laparoscopic surgery for removing the endometriosis ? While this is effective in some selected cases ( those patients with open tubes, good ovarian reserve, and anatomic distortion because of adhesions), it's not helpful for the majority. In fact, in some women, unnecessary surgery actually reduces fertility as normal ovarian tissue is also removed along with the wall of the chocolate cyst, thus reducing their ovarian reserve.

Unfortunately, patients believe that once the doctor has made a diagnosis of endometriosis, this disease is the cause of their infertility; and that once this is "treated", their fertility will be restored, and they will be able to get pregnant in their own bedroom. However, this is also a flawed assumption ! Endometriosis is a very common finding, even in fertile women; the endometriosis found on the laparoscopy in an infertile woman may just be a red herring, and not the cause of the infertility. This is why "treating" it may not help at all !

Similarly, patients with irregular cycles are often very poorly managed. Many patients are unsure about the relationship between their irregular cycles and their fertility, and consider this as a chicken and egg problem. They naively believe that once the cycles are regularised, they will then get pregnant in their own bedroom ! After all, if the reason they are not getting pregnant is the fact that their periods are irregular, then surely fixing the irregularity problem will them to have a baby ! Many doctors also seem to subscribe to this belief, and will regularise the cycles by putting these infertile couples on birth control pills ! While this will regularise the cycle while they are taking the pills, this is hardly helping them to have a baby ! They obviously cannot get pregnant while taking the pill - and once they stop the pill, their cycles continue remaining irregular, because they are still not ovulating !

If you are infertile, how can you make sure your doctor is providing you with the most effective treatment ? The answer is surprisingly simple ! Remember, that the reason you are infertile ( no matter what your actual diagnosis is !) is the fact that your eggs and sperm are not being able to meet. The question you need to ask is - what is the doctor doing to increase the chances of the eggs and sperm meeting ?

Thus, if he is simply suppressing your endometriosis with drugs; or regularising your cycles with birth control pills, he is wasting your time and not doing a good job ! We need to look for solutions - not waste time in finding problems which maybe irrelevant . Fortunately, our technology for bypassing problems ( even without identifying them precisely ) is better than our technology for identifying problems !

Remember, the question should NOT be "Why am I not getting pregnant ? " Rather, it should be - What can I do in order to get pregnant ?" After all, no one cares about problems - we only care about results - about having a baby ! The quality of a doctor’s answers depend upon the quality of the patient’s questions !

Not sure if you are on the right track ? I'll be happy to provide a free second opinion ! Send me your medical details by filling in the second opinion form, and I'll be happy to help !