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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

One of the major reasons patients do not want to do IVF is their fear of injections. They know that during IVF they need to take injections for many days - and many patients are understandably reluctant to take these shots because they have been told that these injections are painful !

While it's no fun to take injections , the good news is that the injections used for IVF treatment are not painful !

Lupron and Anatgon ( which are used for downregulation) and given subcutaneously, just like a diabetic takes insulin injections. these are easy to self-administer and are not painful.

The injections which are used for superovulation ( the urinary gonadotropins such as Menogon) used to be given intramuscularly. IM injections are more painful than subcutaneous injections, because a larger volume needs to be deposited in the muscle; and because the muscles have more nerve endings than the subcutaneous fat. However, these are water soluble , and the pain is usually easy to handle. Using simple tricks ( such as ice-cubes to numb the area; or EMLA patches ) can help in managing the pain.

The good news is that the newer injections used for superovulation - the recombinant gonadotropins such as Follistim and Gonal-F; as well as the highly purified urinary gonadotropins
can also be given subcutaneously. These are not painful at all ( but are more expensive than the IM shots).

So why do IVF patients have the notion that the injections used for IVF are painful ? The painful injections are the oily progesterone injections which used to be given deep intramuscularly for luteal phase support after the embryo transfer. These are the shots from hell which patients never forget - and which leave a major scar - both in the mind and in the butt. In fact, it's these injections which often put patients off IVF treatment for ever !

The good news is that we do not use these at all - and many IVF clinics have stopped using them altogether ! Instead of giving the progesterone intramuscularly, we give it vaginally, in the form of a suppository. While this is messier, it's completely pain -free - and our patients are much happier !

The fear of failure is perhaps the commonest reason why most women do not have the courage to try a second IVF treatment cycle when the first one fails.

But playing it safe has risk as well. If you never dare to fail , you will never succeed !

Here's a great post on how to overcome the fear of failure !

IVF can be a complex process and selecting a doctor can be quite a challenge ! Infertile couples are often frustrated and depressed and most will choose an IVF clinic based on a recommendation by a friend or a referral by a doctor. This is not always the best method and you can end up getting stuck in a poor quality clinic, thus reducing your chances of success. Even worse, many clinics do precious little do educate or inform their patients and patients don't know what questions to ask their doctor.

Also, IVF cycles can fail for many reasons. Sometimes the problem is poor quality eggs - but often it is a poor quality clinic !

Here's the single most important thing you should check, to be sure you are getting good quality treatment.

Insist that your clinic provide you with photos of your embryos ! A good clinic will provide this routinely. This is tangible evidence that they have delivered you with a high quality service - after all, the key output of an IVF clinic is the embryos they produce.

What do bad clinics do ?
- They do not provide photos of your embryos
- They fob you off with specious excuses ( our camera is not working is very popular)
- They just just tell you verbally that the embryos are Grade A
- They "show" you the embryos under the microscope. Unfortunately, for most patients, these just look like blobs - and patients are not sophisticated enough to differentiate between good embryos and bad embryos

Whenever a patient comes to me for a second opinion after a failed IVF cycle , I ask them just one question - show me the photos of your embryos. This allows me to judge objectively how good or bad the IVF lab is - and bad IVF clinics have bad IVF labs !

If you are not sure what good embryos look like, please look at this Visual Atlas of Embryos.


And you can always ask me for a Free Second Opinion !