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An IVF cycle is full of uncertainty and suspense , like any other biological system. However, being prepared for these can help you cope better !

Think of an IVF cycle as being a series of hurdles - and you need to cross all these to reach the finish line ! While most patients will cross these hurdles with ease in a good IVF clinic, each of these is a " moment of truth ".

• You should grow many follicles
  
• These follicles should mature
• Your uterine lining should also mature in synch with your follicles
• Ovulation should not occur before the eggs can be collected
• Mature eggs must be retrieved by the doctor during the "pick-up"
• Your sperm must fertilize the eggs ( with IVF or ICSI)
• The embryos must divide and grow healthily in the IVF lab
• Your embryos should be transferred by the doctor smoothly into your uterus
• Your embryos should implant

Think of it as a series of hurdles, all of which have to be cleared , in order to win the race !

As you can see, how well you negotiate these hurdles will depend to some extent on your biology ( how good your ovarian reserve is , for example); while others will depend upon the skill of the doctor !

A good clinic will guide you through these moments of truth, and share information with you, so that you can rejoice when things are going well - and be prepared in case things do not go as planned. Unfortunately, as with any biological system, IVF is also full of ups and downs - and the more you know about what is happening - and what is going to happen next, the more easily you'll be able to go through your IVF treatment !

We see many patients who have failed multiple IVF treatment cycles in other clinics. Most of them are quite depressed and frustrated. They are not sure whether it's worth trying another IVF cycle with us, or whether they should explore alternative options .

The key question in their mind is - What can you do differently from the other IVF clinics ? What makes you better ?

I enjoy treating these patients . For one, they are a challenge, and if our treatment works where other clinics have failed, this is a feather in our cap ( doctors can be very competitive !)

Also, because they have done IVF earlier, they understand the basics of the treatment, so I can have an intelligent conversation with them and explain what we are going to differently. Because we are a full-service clinic, we can offer additional options which other clinics may not be able to.

These patients can be quite emotionally labile, but because we offer a lot of hand holding in our clinic, along with plenty of personalised support, we can help them to cope quite effectively.

Because we are very transparent in our approach and make it a point to educate patients and actively involve them in their treatment, most patients are appreciative of our approach because it's a refreshing contrast from what they have experienced in other clinics.

What has our experience with these patients been ?

While it's true that success rates do tend do drop in women who have had failed IVF cycles, this is not always true, and there are some refreshing exceptions !

Thus, many patients have taken treatment at sub-standard clinics. Their quality of care has been so poor, that for all practical purposes, all they have done is throw their money away. Doing an IVF cycle for them properly ( the way it should be done !) helps many of them to get
pregnant !

Similarly, some patients with PCOD have been very poorly managed in other clinics. Many doctors are so scared of OHSS, that they end up mistiming the HCG injection, as a result of which they get few eggs and poor quality embryos. We have extensive experience in doing IVF for PCOD patients, and our pregnancy rates are better than 45% per cycle for PCOD patients.
You can read more about this at www.drmalpani.com/pcod.htm !

Patients with male factor infertility are also often poorly managed in many IVF clinics. This is especially true for patients who need TESE and PESA. Because we do these procedures ourselves , we can use fresh sperm, giving us a much higher success rate ( unlike other clinics which have to depend upon an outside andrologist and therefore often have to use frozen testicular sperm which has a much lower success rate )

The other group of patients who are very fulfilling to treat are those with poor ovarian reserve. Because we are willing to use alternative medicine; supplements; and aggressive superovulation, we can often achieve a pregnancy in these patients ( whom other clinics shun because they are considered to be heartsink patients !)

Another interesting trend has been that most clinics in the West use gentle stimulation these days, because they want to transfer only a single embryo. While this works well for women with a good ovarian reserve, it's not the best approach for women with poor ovarian reserve. For these women, because we can superovulate more aggressively, we can often find the one good egg they have in their ovaries, and help this to become a baby !

We see a number of patients who have failed IVF cycles elsewhere, so we have a fairly good idea of what makes some clinics bad.

Here's a short list of features which can help you identify a poor quality IVF clinic

1. Clinics which depend upon outside embryologists to do their procedures for them. IVF is a demanding process and your embryos need the full-time loving care and devotion of an experienced embryologist. A full-time embryologist spends a lot of time honing his skills and optimising the conditions in his IVF lab to ensure high pregnancy rates. This is not something a "visiting embryologist" can do. Thus, these clinics will very rarely freeze spare embryos , and your supernumerary embryos are usually discarded - or donated ( without your content or permission) to another patient.

2. Clinics run by over-busy doctors who travel a lot and are not available in one location. This is a problem for many reasons. These doctors are so busy shuttling from clinic to clinic, that they simply cannot provide the needed care and attention to their patients. While this may not be an issue for many young patients ( who are good ovarian responders), this can be a major problem for patients with poor ovarian reserve or those who develop OHSS. Another problem is that these clinics will often treat patients in batches. This means they will group all their patients together, and do about 10-15 egg collections in one day ! While this works fine for young women this not a good option for difficult patients ! After all, when you have 25 women cycling at one time, how can you possibly ensure that all 25 women will grow eggs at exactly the same time so that they are allready for an egg pickup on the same day ? When there are too many patients , care gets regimented and fragmented, and there is more scope for errors.

3. Clinics with too many assistants. Because there aren't too many good IVF clinics, the good clinics are all very busy. To maximise their patient through-put and revenue, the senior doctor employs assistants. This means that often the history is taken by a junior - and patients rarely get a chance to bare their soul or establish a rapport with the senior doctor. As the treatment progresses, most of the instructions are relayed to the patient by a nurse or an assistant. Once you've paid your fees and signed up for the IVF treatment, you rarely get a chance to see the senior doctor again !

4. Clinics which do not provide medical documentation or records. This is a major problem because IVF clinics want to "hang on" to their patients. They are worried that their patients may desert them or go to another doctor, which is why they treat the patient's medical records as their personal property - and refuse to give even a copy to the patient. A good clinic should routinely give you a treatment summary as well as photos of your embryos - and if they do not, then you should be very concerned !