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The newest IVF technology uses a fancy new technique which marries IVF and genetics. This is called PGD ( preimplantation genetic diagnosis) with CGH ( comparative genomic hybridisation) and there are lots of press releases and articles touting this as the newest breakthrough !

Doctors , like all big boys, love to play with new toys - and the newer the better ! This is especially true when they have expensive new technological tools, which no other competitor has. Doctors can be very competitive - and are always trying to be one-up on each other. An easy way of being different is to use the newest technology - but the trouble is that never is not always better ( though newer is always more expensive !)

Because these new tools are so expensive , doctors need to use them extensively, to justify the expense - after all, they need to show the bean counters who pay their salaries and bonuses that the new tool is cost effective !

The key question thoughtful patients need to be asking is - Is it really better ? Or is it a solution looking for a problem ?

I think the truth is we really don't know right now ! It's very likely to be useful for some patients - but to expect it to be useful for everyone across the board is hoping for too much ! While it may seem logical to use PGD, unfortunately, biological systems are not always logical ! What seems to make sense in theory often does not

As a doctor in clinical practise , whose major focus is simply to get as many of my patients pregnant as quickly as possible, I am quite conservative and prefer to wait and watch.

I follow Alexander Pope's dictum,
Be not the first by whom the new are tried,
Nor yet the last to lay the old aside.

Only time will tell how useful PGD-CGH is - but the enormous commercial pressures under which IVF clinics operate - and the constant demand by patients that their doctor use the newest and the latest breakthrough technology they read about in the newspaper means that most IVF clinic will likely end up overusing it !

For many patients, the emotional stress of going through an IVF cycle is far more than the physical stress ! The overriding fear is that of failure – what will I do if the cycle fails ? Will life be worth living ? They understand that IVF is the one treatment option which maximizes their chances of having a baby and have pinned all their hopes and dreams on the cycle succeeding. They dread to entertain the possibility of failure , as a result of which they are emotionally very vulnerable.

Even before starting the IVF cycle, they spend a lot of time and energy doing their homework. Some will do their research and become an expert on IVF; others will doctor shop; while some will go to a temple to make sure God is on their side !

While there are quite a few ups and downs during the moments of truth during an IVF cycle, the fact that there is so much action ( are the follicles growing ? do we have enough eggs ? are the embryos of good quality ?) , the mind is extremely hard to manage during the 2ww , and plays havoc during this time.

While your head knows you should be detached, and that the final outcome is now out of your hands, your heart finds it hard to do this ! You look for omens and signs all the time ! Everyone ( especially your husband ) tells you not to “ stress “ , but how can you possibly not stress about this – after all, so much rides on this ! While your friends are sympathetic and caring, they just cannot understand what you are going through. Every minute seems to take an hour to pass – and you are never sure whether to be hopeful ( because you’ve read somewhere that being positive increases the chances of success ?); or to be prepared for failure ( so that it’s easy to deal with the emotional roller coaster ride). Unfortunately, many doctors make a bad situation worse by forcing their patients on “bed rest” after the embryo transfer. When you lying in bed all day long, it’s hard to stop your mind from imagining the worst !

Unfortunately, there are no reliable symptoms or signs which can predict what the outcome will be. The symptoms are exactly the same, whether or not you are pregnant or not. This is hardly surprising, given the fact that the symptoms of PMS are exactly the same as those of early pregnancy – and that all the hormones you are taking for luteal phase support are the same hormones your body produces during pregnancy !

You need to find ways to cope constructively ! Think of this as a learning opportunity which can test your emotional resilience. Tap into your inner strengths and remember you have dealt with waiting in the past as well – waiting for exam results; or waiting for your boyfriend to call ! The waiting game is exactly the same and learning mind management skills such as yoga and meditation can help ! Keeping yourself gainfully occupied and continuing to work is very useful – this keeps you distracted and allows you to channel your energies constructively !

I see many patients who have failed IVF cycles in other clinics. In order to improve their chances of success, I ask them basic questions about their earlier cycle: How many follicles did you grow ? How many eggs were retrieved ? What was your embryo quality ? Surprisingly, many are quite clueless , and know very little about the medical details of their treatment cycle, because " my doctor did not tell me anything " ! They are often upset and angry- and resentful that their doctor did not share more information with them.

After realising how much their doctor has kept them in the dark, they conclude that they made a mistake in the doctor they selected. They feel cheated and start believing that they can no longer trust any doctor.

One of the reasons for their bad choice is because they did not do any research or homework before starting their IVF treatment. Many people just go to the nearest IVF clinic - or just blindly follow their family doctor's advise.

This is not a happy situation, and ends up hurting both good doctors and patients. It's especially tragic when IVF patients who have had a bad experience refuse to try another doctor, because they then lose the opportunity to take treatment with a good doctor !

When you make a mistake, you should learn from it; forgive yourself; and move on. I tell all my patients - It's OK to make a mistake once - just make sure you don't make it again !

We were a happy carefree couple, enjoying our freedom to do things that we liked, for the first four years of our marriage. And then when we finally thought of starting a family…. It didn’t happen for another year and we were happy childfree couple. Couldn’t figure out initially what can go wrong, but when we decided to do a reality check, we landed up at a neighborhood Obs&G’s clinic. She ran a few preliminary tests which didn’t point to anything in particular, prescribed few medicines for me. Six months later, the same tests were repeated again, and again. And then I was referred to a urologist for surgery for a suspected varicocele. That’s when it dawned upon us that may be we are knocking on the wrong door!

After a couple of months & a million clicks on the net, we decided to go to a specialist. The research on the net had classified us suffering from “unexplained infertility”. We landed up at Dr Malpani’s in search of explanation. Few new tests were prescribed for my wife and same old ones for me. Everything looked normal to the doc, which was a source of confidence that it would happen sooner or later. We were suggested to try IUI at our local gynec for 3 cycles. There was a hint of sadness creeping up after every unsuccessful IUI. Doubts started cropping up… Did we leave it for too late to start the family? We were back to the drawing board. Dr Malpani assured that everything was ok and he suggested IVF and we decided to go ahead. It’s to the clinic’s credit that the entire process is handled so systematically & in such an organized way that it gives you the confidence that every thing possible will be done, without going overboard,
to make it a success. The entire IVF process went as planned by the doctors and bingo…now we have graduated from being TTC couple to 12 weeks pregnant!

A BIG thanks to both Dr Aniruddha & Dr Anjali and their team!

mum.pgs@gmail.com

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 !

Everyone knows IVF has a limited success rate and that there are no guarantees in medicine. If that's the case, then why do we offer an IVF guaranteed pregnancy program ?

Is this just a marketing gimmick ?

No ! There are lots of benefits to this option, both for our patients and for us.

For one thing, this option bolsters the patient's confidence levels ! Patients who have failed IVF cycles elsewhere have lost confidence in doctors - and in themselves. Before starting the IVF cycle, most clinics promise the moon. However, when the cycle fails, the patient becomes a leper and the doctor becomes inaccessible ! Finding a doctor who is is willing to put his money where his mouth is helps them to rebuild confidence in the medical system !

This option also helps patients to have realistic expectations of the IVF treatment. For many patients, IVF is their last resort. They are fed up and frustrated and do IVF with a lot of hope that this high-tech expensive method with such a high success rate will finally give them the baby they have longed for for such a long time ! When the IVF cycle fails, this is often the last straw which breaks the camel's back, and they are shattered, disheartened and dis-spirited. This is why the drop out rate with IVF treatment is so high - very few patients have the emotional stamina to do more than 2 cycles. It's true that IVF can be an emotional roller coaster ride, but when patients think of IVF in terms of a single cycle "sure shot" technique, they are setting themselves up for unhappiness. Even worse, by not repeating the cycle, they are depriving themselves of their best chance of having a baby !

The guaranteed pregnancy option is very useful as it helps them to reframe their perspective . They look at the treatment more realistically and realise it's not always a 100 meter sprint. The are willing to work with the doctor - and give the technology enough time and opportunity to maximise their chances of success.

It also helps them to regain control of their life. This option helps them to establish a timeline , so they have a clear road map of what they will do ; when they will do it ; and when they will move on to Plan B. Otherwise, when an IVF cycle fails, many patients are paralysed into inactivity - and they do not have the heart or the stomach to try again ! When they make a 4-cycle commitment upfront, they realise they are in it for as long as it takes , which is far more
realistic !

This option also helps them to move on with their life. Even if they do not get a baby at the end of it, at least they have peace of mind they did their best, in a systematic and well-organised fashion, so they do not have any regrets when they are looking back at the age of 50 !

It also helps to reduce disputes between husbands and wives. Men are from Mars and think only with their heads. Women , on the other hand, think with their heads and their hearts, and this just ends up confusing their husbands. This option ensures both are on the same page - and that they will remain there, even if the cycle fails ! This makes it easier for the husband to console his wife if the cycle fails, because they have something positive to look forward to !

Everyone knows that IVF success rates improve with repeated attempts - and the cumulative conception rate in our clinic after 4 cycles is 87% ! I usually tell my patients - I am very sure we will be able to give you a baby - it's just that I don't know when this will happen, as I am not a fortune teller !

This option is very helpful from a medical point of view as well. It allows us us to learn how the patient responds to the treatment, so that we can continually improve and fine-tune the treatment protocol until we achieve success ! After all, every woman is different, and we need to tailor or protocol to her response - a process which can take time ! This option allows us to learn from each cycle, so we can move closer to the desired goal !

Can we offer this option to all patients ? Sadly, no. We restrict it to patients with a good prognosis, allowing us to create a win-win situation.

Does this make any financial sense for us ? In case the 4 cycles fail, where does the money to pay back the patient come from ? Do we lose money ? No, we don't. In what I think is a way of sharing risk amongst patients by pooling them together, the patients who get pregnant ( and " overpay" us) end up subsidising the treatment of those who fail !

Does this make financial sense for the patient ? Yes, definitely ! For one, it protects you against a future price rise, as you can do your 4 cycles any time you want over a 2 year period. Also, there is no additional cost for freezing your embryos and transferring them. This means that if you have frozen embryos, you get a number of additional free "bonus" cycles - at no extra cost to
you !


We do sign a legal binding contract before we start the treatment, so the patient is protected and secure. While the actual medical protocols we use are the same for all patients, whether they use the standard single cycle pay as you go option, or the guaranteed pregnancy option, over the years we have observed that patients who select this guaranteed pregnancy option have a much higher success rate !

My husband and I have been married for seven years, and are now 11 weeks pregnant! Even with the euphoria of this moment I don’t want to forget the journey of three years that brought us here, and Dr. Malpani and his team have been like a guiding light in this.

The ‘TTC’ Couple

We wanted the first few years of our marriage for ourselves and made the most of them by traveling all we wanted, my establishing myself in my career and having time with each other. After the fourth year we started trying for a baby, once the initial 7-8 months were over we started to think that we should get a medical opinion so that we can eliminate the possibility of a problem or rectify it if there’s one. We met our OB&G and she suggested a few basic tests, based on these she started some medication for my husband and suggested we keep trying. We spent months doing back and forth like this, changing medicines, feeling disappointed every month. After almost a year of this and a suggestion for a surgery for my husband, we started doing some research for an infertility specialist and from what we found online, decided to meet Dr. Malpani.

Onwards March!

Once we met Dr. Malpani and talked to him, the doubts eased and I felt this confidence that while it may take time we were finally on the right track and this will happen for us. That confidence is the biggest asset the doc equipped us with which saw us through the entire process on good days and bad. Based on the battery of tests we did there wasn’t a reason or problem to explain the delay, so it was decided that we will try with 4-6 cycles of IUI first. We live an hour’s drive from his clinic so the Dr. suggested we do it with a trusted OB&G nearby and gave us the treatment to be followed. We did do three cycles of IUI with our Gynecologist but without super-ovulating. These IUIs did not work and when our Gyneac suggested that we do a diagnostic laparoscopy, which I knew (from the website) was not commonly done anymore we decided to go back and consulted Dr. Malpani. He gave us the options and we decided to go ahead with the IVF!

Mission IVF: Putting our eggs in a safe basket

Every day of the process from the word go I have thanked our lucky stars that we decided to do this with Dr. Malpani and his team. To NOT worry about if you were being told everything, if the staff knew what they were doing, if you were being told to do things that weren’t necessary, if we will be charged correctly, if an important detail will be missed out etc. etc. ; to NOT have to worry about these made it as easy on us as it could have been. Everything was done in a very systematic manner and the staff members were not just cooperative but clear and aware of everything that needed done. I had come to trust them so much to do everything with precision that I drove to the clinic for each of the shots instead of doing it closer home with someone who might mess it up. The egg retrieval and ET were done in the way which was already explained to us, we were shown the three grade A embryos before the transfer and I have to say that was a pretty exciting moment! The transfer happened in a smooth, painless manner and I left the clinic with the feeling that all that could have been done by us and the Drs. had been done. The 15 day wait as everyone says was excruciating and I kept trying to prepare myself for either of the outcomes. When the first HCG blood test came out positive I decided to wait for the second and the third HCG before I told myself that this was really happening. It is! I’m enjoying these months and looking forward to everything going smoothly for my due date in September. And I’m just really thankful that we got to do this with a doctor who has the answers and a sense of humor!


mum.pgs@gmail.com

I just saw a patient who was 40 years old; she had had 2 miscarriages; and she wanted me to do surrogacy for her. I spent a long time explaining to her why I did not think this was her best choice. Surrogacy is an expensive and complex treatment option, which is best reserved for
women without a uterus. Research shows that the reason for failed implantation is much more likely to be genetically abnormal embryos ( because of poor quality eggs), rather than a uterine problem.

Her reasoning was completely different. The fact I got pregnant means my eggs are OK ! The fact I miscarried means my uterus is defective because it could not hold the baby. This means that if use a surrogate uterus, I will have a baby !

The reality is completely different. The fact that she conceived means her uterus is fine because it allowed the embryo to implant ! However, because the embryo was genetically abnormal, it could not grow any further ! We know that the commonest reason for a miscarriage is a genetic abnormality in the fetus, and this is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which cannot be screened for. From a purely medical perspective, using donor eggs would be a much better option as it would give her a much better chance of having a baby ! This was my recommendation to her, which she found quite hard to accept.

Logically, it makes no sense for me to clear her misconceptions. After all, I should be quite happy to do surrogacy for her - this is what she wants and I can charge her much more for it ! However, I refused to treat her, and suggested she find another doctor.

I have observed that there are 2 kinds of patients. One group treats me as a professional. They are looking for medical advise and guidance; and want my professional inputs. They have an open mind, and are seeking to form a partnership with me. They want to tap into my professional knowledgebase, so they can make the right decision.

The other group treats me as a technician. They already know what they want - they just want me to do this for them. While this may not be great for my ego ( after all, doctors expect patients to do everything they tell them to !), I am mature enough not to get offended, and am happy to listen to my patients and weight their inputs.

Does this mean I am wishy-washy and will do everything my patients ask me to ? No !

I use a combination of rigidity and flexibility. I am happy to accept patient inputs and preferences and modify my protocols, as as long as they do not affect the outcome ! For example, if patients want us to use the long protocol rather than the short ( which we prefer because it needs fewer injections !)

Similarly, some patients want to use rec FSH for superovulation, instead of the urinary HMG we prefer ( because it's as good and much less expensive !) and I am happy to comply.

However, I will not allow them to do anything which I feel is not right ! I am a professional , and
the buck still stops with me. I will not let them make a wrong decision, no matter what. Thus, if a patient asks me to transfer 5 embryos , I will request them to find another doctor.

Many patients come to me with preconceived notions, especially if they have done IVF treatment elsewhere. Websites and Bulletin Boards are also powerful sources of information - both good and bad ! These patients can be quite a challenge for doctors . If they are well-informed, we can learn a lot from them - but if they are not, it can be quite frustrating to get them to separate facts from reality !

Try and try till you succeed....i think this mantra holds not only in your professional life but personal too....

After two years of trying for baby and undergoing two laproscopies ,two iuis and one failed ivf we were devastated....we thought we can never have a child of our own....but then by God's grace we came across the web site of Dr Malpani..Oh it was so informative! i posted my history and there came a very positive reply..there was a ray of hope...we made up our minds to give ourselves one more chance so that we don't repent later.

We visited Dr Malpani clinic in May 2009 for the first time and i must say there is something in his clinic..i think its God's blessing to them...the environment is so positive and cordial and Dr Malpani is so very approachable and positive too that we immediately felt we had come in right place and were in right hands.

We underwent two IVF cycles one in July and other one in Oct 09 but unfortunately both resulted in chemical pregnancies....however we were still happy that atleast something was happening..i was getting pregnant which had never happened before! Then our 3rd cycle was a ZIFT in Feb10 which also did not work out....but atleast our embryos were frozen for future. Our 4th cycle was planned in Aug10 ie IVF with frozen embryo transfer.I must say since our embryos were frozen so this cycle was very very less stressful and required just two visits to the clinic!...AND THIS TIME GOD WAS WITH US..

YES i got pregnant in this cycle that too with twins!! Our joys knew no bounds...we were on CLOUD9!! We immediately informed Dr Malpani about it..he was also very happy for us.
Presently i am in 32 weeks of pregnancy and just waiting to hold my babies in my arms and even now Dr Malpani calls up and asks for my well being and answers all our queries inspite of his busy schedule and mad rush in his clinic. This shows his true dedication for his patients.
I WOULD RECOMMEND Dr MALPANI TO EVERYONE TRYING FOR THE BABY.THEY ARE TRUE PROFESSIONALS.

I must also mention about Dr Anjali who has an equal or rather more role to play along with her husband.She is a sweetheart and very professional.She is the one who did all my transfers and finally made me pregnant! Also Dr Sai,the embryologist and all the staff in the clinic are true professionals and do their jobs very well....that's why the success rates are so high. I would like to wish them all the best for future and may they continue to do the noble cause.

neha_sh1980@rediffmail.com

This is one of the commonest questions patients ask me. A good IVF clinic is quite good at making good embryos in the lab. However, once they are transferred into the uterus, then whether they will implant to not is a biological process which is not in anyone's control ! It can be quite scary to think that the fate of your embryos is in your hands - and that if you make a false move, you may lose the embryos !

The actual IVF treatment, leading upto the egg collection is full of action ! You are taking injections every day and the doctor monitors you closely. It's fun watching your follicles grow on the ultrasound screen and actually seeing your embryos can be a very emotional moment in your life ! However, after the embryos are transferred, you are pretty much on your own. You have no idea what's happening to your precious embryos inside your uterus and there's no medical monitoring or contact, so you are pretty much in limbo until the day of the HCG test. Not for nothing do women dread the IVF 2ww !

Your mind plays all kinds of games with you ! Are your breasts feeling fuller than usual ? Was that a uterine cramp ? Does the discharge you are getting mean the embryos are falling out ? Does the backache mean the cycle has failed ? Is the bloating PMS or an early symptom of pregnancy ?

You try to compare notes with other women - but realise that there is so much variability and so many old wive's tales, that it's hard to make sense of anything which is happening to you. Your imagination runs riot - and your husband can be completely unhelpful when he tells you to "stop stressing out" and to "just relax" !

It's difficult to find anyone who can empathise with the suspense and anxiety you find yourself in - and every hour seems to last for one day . You are petrified that a false move will jeopardise your precious embryos ! Is it safe to run to catch the bus ? Is it OK to drive ? Does straining in the bathroom cause the embryos to get dislodged ?

Just what's happening in your uterus ? Are the embryos implanting ? Or dying ?

The truth is that there's very little you - or anyone else - can do to affect the outcome of the cycle after the transfer is over - it's very much a "no-woman's " land ! Because human reproduction is an inefficient process, most embryos do not implant to become babies. This is true in the bedroom as well, but when the embryos do not implant after an IVF cycle , women always blame themselves !

" I killed my embryos ! I let my family down ! I will never give my husband a baby ! I am cursed ! I failed again !" These are familiar refrains you may hear, even though you do your best to remain calm and collected.

What makes a bad situation worse is how clueless your husband can be ! He often does not know what to say - and what he does say, he often does badly. He may say things like - " Don't worry - it's not the end of the world ! " " I am sure it will work the next time !" And you feel like saying - " You are an idiot if you do not realise it is the end of my world ! " " And how do you know it will work the next time ? " The poor guy is just trying to provide moral support, but you may find yourself taking our your anger on him !

And the "well-wishers" who blame the IVF failure on the fact that you did not rest or took too much stress are often the last straw which can break your back !

Please do not beat up on yourself ! While doctors do provide luteal phase support with hormones to try to improve the chances of successful embryo implantation, the truth is that the outcome of every IVF cycle is always unknown. All you can do is to improve your odds by finding a good clinic - the rest is outside your hands !

Please remember the Serenity Prayer
God grant me the serenity to accept the things I cannot change;
the courage to change the things I can;
and the wisdom to know the difference.

Infertile patients can be desperate for a diagnosis. They naively feel that once they know what the problem is, we'll be able to find the solution !

This leads to testing - which has now become an epidemic of overtesting.

Let's see why. Patients still have unrealistic expectations from IVF treatment. Doctors often do not bother to counsel them. They are so focused on "grabbing patients" to do one IVF cycle, that they overpromise success. They make tall claims during the IVF cycle to keep the patient's hopes high - everything is going very well- you will definitely get pregnant ! Then, when the cycle fails, the doctor becomes inaccessible ! Patients get disillusioned and hunt for a new doctor. The new doctor needs to do something more - something different - as compared to the old one - after all, he needs to show the patient he is better !

The new doctor will then order a whole panel of expensive new tests. Many of these are completely irrelevant and do not affect fertility or the IVF treatment, but patients are quite clueless and do not know any better. They are happy to do whatever the new ( and improved !) doctor suggests - after all, aren't more tests a sign that this new doctor is very thorough and competent ?

An excellent example of this is : PCR for TB testing in India; immune testing for killer cells in the US; and sperm DNA fragmentation tests.

All doctors know that if you do a lot of tests , it's a matter of statistical certainty that you will find an abnormality. Once this is found, this is considered to be the problem causing the infertility which then needs to be fixed ! The new doctor is triumphant ! See, the earlier doctor was incompetent and did not bother to test you properly which is why the cycle failed. Aren't you glad you came to me ? Now that I am treating you , this problem will be solved and you will get pregnant !

Patients are happy too ! They are impressed by how well-informed and thorough the new doctor is. In fact , is sometimes seems that the more the tests - and the more expensive they are, the happier the patient - and the happier the doctor !

This leads to a negative vicious cycle of overtesting and overtreatment. Doctors often end up "treating" red herrings. All this just wastes time and money - and then the new doctor fails, then
patients lose confidence in doctors - and in themselves !

Caveat emptor - do your homework before agreeing to do tests ! And always ask this simple question - How will this change my treatment ?

We deal with a number of difficult patients who have failed multiple IVF cycles elsewhere. Many of these are poor ovarian responders and a common question is - How many follicles do you need to go ahead with the treatment ? Is there a number in your clinic below which you will cancel the cycle ?

These patients suffer from a lot of anxiety and apprehension during the superovulation, because they know they are not likely to grow many eggs. They have already had many of their cycles cancelled in the past - and this can be quite a cruel thing to do , because these are eggs which they have produced with a lot of effort ! Their eggs are precious - and represent their best chance of their having a baby with their own genes. This is why when the doctor cancels the cycle because they have not produced enough eggs, their heart breaks.

From the doctor's point of view, cancelling the cycle seems to be a very rational thing to do . Why make the patient spend so much money when the chances of success are so slim ?

What they forget is that the patient knew prior to starting the cycle that the chances of success were slim, so that the fact that she has grown few eggs has not really changed anything. If she's prepared to take that slim chance it can be cruel to deprive her of it

It's especially cruel when the real reason doctors cancel the cycle is because of "clinic policy" - because they do not want to mess up their success rate statistics !

These are challenging patients, and during superovulation, the major worry is - Will we reach the stage of egg colleection ?

Many doctors will cancel cycles if there are less than 4 follicles, because poor responders have a lower success rate and they do not want to harm their clinic IVF succcess rate. These are league table games clinics play, where they weed out the difficult patients to artificially elevate their published succcess rate figures.

We need just one follicle to go ahead, as long as the patient has realistic expectations and understands that there are still many more hurdles to be crossed after egg collection: there may be no egg; or the egg maybe immature; or it may not fertilise. We can be aggressive and are happy to do our best to help the patient to have a baby, but sometimes biology can be cruel !

With this approach , our patients have peace of mind they did their best ; that they explored all possible medical options and did not leave any stone unturned. With this approach, it's often easier for them to move on to Plan B ( adoption or donor eggs) because they know they've given it their best shot.

The outcome is always uncertain, and I do not want them to regret the fact that they did not try. We do our best to work with our patients - even if this brings down our success rates.

HCG ( also known as beta HCG or just beta) is a very special molecule. It's unique in that it's produced only by the placenta ( very very rarely, it's also produced by some ovarian and testicular tumours). This means that for all practical purposes, it's found only in pregnant women and is therefore a very good marker for pregnancy.

Since the HCG is produced by the placenta, the levels of HCG rise as the pregnancy develops, and there is very good correlation between the health of the pregnancy and the HCG level for the first few weeks of the pregnancy ( from about week 4 - week 7, as calculated from the LMP, last menstrual period).

However , it can be hard to make sense of your HCG blood levels. Let's look at some of the pitfalls in monitoring your beta levels.

Most patients naively assume that a beta of more than 1 mIU/ml means that it's positive and that they are pregnant. This is not true. The new kits are very sensitive , and even men can have levels of upto 10. This means that a level of less than 10 mIU/ml should be considered to be negative.

Secondly, remember that the HCG is produced by the placenta and not by the fetus. This means that the HCG levels may rise , even if the pregnancy is not viable ( such as an anembryonic pregnancy or a missed abortion).

Since HCG levels rises exponentially, there is a very very wide range of normal. This is why it's very hard to interpret just one level in isolation . It's important to check at least 2 levels at least 48 hours apart to determine the trend . In a healthy pregnancy, the levels should double every 48 - 72 hours. If they do not do so, this suggests your pregnancy may not be healthy.

It's not possible to determine whether the pregnancy is single or multiple based only on the HCG level. While it's true that HCG levels are higher in multiple pregnancies than in singletons, because there is so much overlap, you cannot jump to any conclusions based on the HCG level alone. This is why it's important to interpret the HCG level in conjunction with vaginal ultrasound scanning results.

Also, normal ranges can vary widely from lab to lab, because they use different kits. This is why it is important to check your HCG level from the same lab each time !

Finally, HCG levels are useful only in the first 7 weeks of pregnancy. After this, ultrasound scans are far more useful because they provide much more information about the location of the pregnancy; how many sacs there are; and whether the fetus is growing or not.

NORMAL SINGLE PREGNANCIES

Day after HCG or LH ( DPO)	Average mIU/ml	High mIU/ml	Low mIU/ml	#
14	48	119	17	12
15	59	147	17	18
16	95	223	33	23
17	132	429	17	21
18	292	758	70	19
19	303	514	111	23
20	522	1690	135	13
21	1061	4130	324	12
22	1287	3279	185	22
23	2034	4660	506	13
24	2637	10000	540	16

The information in the table above is part of a study carried out by Dr. Sherbahn

I am the classic case of a woman who postponed starting a family to focus on her career while never believing that one day she would be facing infertility issues. I even believed that I could choose the month I wanted to get pregnant! I was almost 34 years old by the time my husband and I were out of school and settled enough in our jobs to start our family. I guess that is not really so old if there are no fertility issues, but if there are then time is definitely not on your side. By the time I turned 35 years old, we were living in Europe and began seeing a infertility specialist. In the middle of all the standard infertility tests, I managed to fall pregnant naturally. Our joy did not last long because at 8 weeks pregnant all that could be seen on the ultrasound were two empty gestational sacs. Nonetheless, the doctors felt that I had a good chance of getting pregnant naturally. I even had a laparoscopy done which showed that nothing was wrong. The doctors believed we had a good shot at IUI so we did 3 unsuccessful cycles before moving onto IVF.

I was 36.5 years old (tick tick tick) by the time we did our first IVF cycle. I always responded well to the medicines so we were confident that IVF would work for us. Our first cycle failed and our second cycle resulted in a chemical pregnancy. Frustrated after our third unsuccessful cycle, we changed clinics and found a doctor that would take a more aggressive approach. After two failed cycles, we changed clinics once again. The next cycle at the new clinic ended like all the others. in which I had 3 decent looking embryos transferred on day 3 but none of them implanted. The obvious conclusion was that there was a problem with my eggs. At this point, after 6 failed fresh cycles, I felt I had enough and could not endure another cycle. Above all, I did not think I could get pregnant with my own eggs. One of the worst things about infertility is that it slowly damages your self-esteem. No matter how much you know in your head that it is not your fault, you can not help but feeling like a failure. And as if that isn't bad enough, I would like myself even less because of all the feelings of anger and jealousy I had. But above all, I could not imagine living the rest of my life without children.


We searched the internet for egg donor options. In most European countries, it is illegal to pay egg donors so there are very few and the wait list is quite long. In the U.S., egg donors cost a fortune. We came across Dr Malpani's website. I was impressed by how much information was on the website, but most of all I was impressed with how well the emotional aspects of infertility were addressed. I began emailing Dr Malpani and he was always quick and thorough in answering all my questions. In fact, he was so quick in replying to my emails that I thought there must be something wrong! At one of the clinics we had been treated at we could not even talk directly with our doctor without making an appointment a few weeks to months in advance. After answering many of my emails, we felt that this was the right choice for us, but even so I was still a little unsure about going to a clinic in India and never having been there before or met Dr Malpani in person.

Dr Malpani found us an egg donor and 2 months later we were in Mumbai. I was still unsure about what to expect, but all my fears were laid to rest when we went to the clinic and were waiting with many other couples from around the world. Then after meeting Dr. Malpani and Dr Anjali Malpani I knew we made the right decision. We spent about a week and a half in Mumbai which was like a holiday for us. Everything was very smooth and easy.

After I got back, Dr Malpani continued to answer all my emails and ease my mind whenever I started to obsess negatively until I took my pregnancy test and got a positive result! We were so excited but still cautious until finally we saw and heard a beautiful little heartbeat at 6 weeks. Now I am experiencing all the joys of being pregnant, including the dreaded nausea!

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 !

One of my patients recently asked me - Which protocol is better for IVF - the Letrozole Antagonist Protocol vs the Estrogen Priming Protocol ?

( In passing, I'd like to point out how impressive it is that patients are so well informed about medical minutiae ! Most gynecologists are quite unaware of all these finer details !)

Actually, the principles of any superovulation protocol for IVF are extremely simple. Superovulation forms the heart of modern IVF. We use medications to help you grow more eggs. Every month you start to grow about 30-40 follicles, but in a natural cycle, most of these undergo atresia (die), so that only one matures every month, in the normal course of events. With the help of medications, we are able to rescue follicles which would otherwise have died, so that we can help you to grow many mature eggs in one cycle.

Since follicles grow in response to the hormone FSH ( follicle stimulating hormone), this is the most important medication we use for IVF. This comes in many different forms . The traditional medicine has been urinary gonadotropin ( menotropin or human menopausal gonadotropin). Brand names include Menogon and Repronex ). This has been the work-horse of IVF for many years and is still the most cost effective medication available !

The gonadotropins now come in many new ( and much more expensive !) flavours, including the recombinant ( rec) gonadotropins, which are produced in vitro in a bioreactor. These are the rec-FSH and rec-LH preparations, and brand names include Gonal-F and Follistim. All these are very similar as far as their clinical activity goes , though the recombinant drugs are much more expensive ( and are therefore promoted much more actively, even though they are no better !)

We can also use tablets such as letrozole to help you grow more eggs. These act by boosting the prodction of your own gonadotropins, thus helping you to grow more eggs.These are much gentler and much less expensive , and are very useful for the minimal stimulation IVF programs.

So if all we need to make you produce more eggs is to superovulate you with medications, why is this such a big deal ?

Remember that we also also need to prevent the eggs from bursting on their own. We need to time egg collection in an IVF cycle very precisely. We want to collect mature eggs before the follicles rupture. We cannot afford to go in too early ( or we will get only immature eggs); and neither can we wait too late ( or the follicles will rupture and we will lose the eggs).

Since we know that spontaneous follicular rupture is triggered off by an endogenous LH surge which is initiated by the pituitary gland, the drugs we traditionally use to prevent this spontaneous follicular rupture are the GnRH agonists. Brand names include Lupron and Buserelin ; and these switch off your pituitary gland, preventing it from producing any LH. However, they take a long time to act and need to be given for at least 10 days in order to be effective. These were administered as either a long protocol ( from Day 21 of the earlier cycle; or a short protocol ( starting from Day 1 of the cycle).

The newer generation of drugs which allow us to equally effectively prevent the spontaneous LH surge are GnRH antagonists, such as Ovurelix and Cetrotide. These act much more quickly, which means they can be started from Day 7 onwards, which means you need to take fewer shots ! However, these are much more expensive , as compared to the GnRH agonists, and are no better than them as regards their clinical efficacy.

In reality, pretty much any protocol works well for patients with good ovarian reserve, so there's not much to pick and choose between them, and most clinics get good results with whichever protocol they are comfortable with.

However, some patients can be quite tricky. These include patients with PCOD, who have a high risk of getting OHSS. They need much gentler superovulation, and closer monitoring.

The really difficult patients are the ones with poor ovarian reserve. They have fewer eggs left in their ovaries, which means they respond poorly to the standard superovulation protocols.

It is for these patients that doctors have developed newer protocols, in the hope that we will be able to coax these ovaries to produce more eggs !

A lot of the emphasis is on precycle preparation. The hypothesis is that if we treat patients prior to starting their IVF cycle with estrogens ( the estrogen priming protocol) or androgens ( such as DHEA) , they will produce more eggs because more follicles will be recruited when we start the superovulation . Many doctors will also use supplements like wheatgerm , Vit D3 and CoQ 10; as well as alternative medicine ( yoga and acupuncture) to boost ovarian response.

So much for the basics . However, I find many IVF doctors seem to deliberately complicate matters . They love coining fancy new names for their "new" protocols ( which are actually very similar to each other in reality !)

Why do they do this ? I think there are 2 reasons. If you use long complex technical names, this helps to put patients in their place . If you make it complex, patients don't ask too many questions because they are out of their depth, and they respect you even more because you are the expert who has mastered all these esoteric medical details !

Doctors also have a fascination for anything which is new . Doctors like to innovate - and it's fun to design and do something new !

Finally, it's a clever marketing ploy, because it helps to attract patients who have failed IVF cycles elsewhere. Patients who have failed IVF are desperate to do something different ( and preferably something new !)

Just remember that new is not always better - and please try to understand the principles behind the treatment, so you do not get taken for a ride !

I see patients who have done IVF cycles in other clinics all the time. How they responded in the earlier IVF treatment cycle provides me with valuable information, based on which I can tailor a better treatment protocol for them.

One of the basic questions I ask them is - Please tell me more details about your earlier IVF cycles . What were the meds which were used for superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? How many embryos were transferred ? What was the embryo quality ? DO YOU HAVE PHOTOS OF YOUR EMBRYOS ? What was the endometrial thickness ?
Can you please show me the printed treatment summary from your IVF clinic ?

Many of them look at me blankly. ( I am sure some of them wonder why I expect them to know all this - after all, they are just patients, and not doctors ! )

Others get defensive and say -
" The doctor did not tell us anything. "
" The clinic does not provide medical records. "
" They keep a copy of the medical treatment and do not give the patient anything at all."

Now I think that any clinic which does not routinely give the patient a treatment summary of their IVF cycle at the end of the treatment is a bad clinic . However, while the absence of the medical treatment summary reflects badly on the doctor who provided the treatment, it is also a reflection of the fact that the patient has been a bad patient as well !

" The doctor did not give me a copy of the records " is not a good answer. Getting a copy of your medical treatment details is not only your right, it's your responsibility as well ! And if you do not assert your responsibility, then you are as much to blame as the doctor is !

It takes two to tango - and while you cannot change someone esle's behaviour, you can change your own ! Start off from the first visit by observing what happens in the clinic. Does the doctor give you a copy of your consultation sheet ? your lab tests ? Do other patients have their records with them ? Ask at the first visit itself what the clinic policy is about medical documentation.

If your doctor refuses to give you your records after your treatment is over ( because he does not want you to go to another doctor), then you need to become assertive ! Ask for a copy of your medical records - and make this request in writing, with a copy to the Administrator of the Hospital. If you do not get a reply, then ask your lawyer to write the letter for you - I can guarantee this will produce results !

I want all my IVF patients to become an expert on IVF , which is why we spend a lot of time and energy in educating them; and in creating unique online educational tools to help them to learn more about IVF.

Now, I am not trying to teach my patients how to do IVF in their bedroom ! The reason we want them to know as much about their treatment as possible is because this is the best way of explaining to them why we are so good at what we do - and what makes us better than other IVF clinics . The outcome of any IVF treatment is always uncertain, and no matter how good I am , there is no certainty that the IVF cycle will be successful. Also, it's a very competitive field, and there are over 40 IVF clinics in Bombay itself ! Sadly, most patients are quite clueless, and do not have the ability to differentiate between a good IVF clinic and a bad IVF clinic.

If we actively involve patients in their IVF treatment, they are better able to understand what makes us one of the best IVF clinics in India. When they understand the science behind IVF, they appreciate all the time and effort we take in monitoring them and in personalising their treatment . We work hard in order to help our patients to have a baby, but only well-informed patients can truly appreciate all the effort which goes on behind the scenes !

Also, well-informed patients have realistic expectations from the IVF treatment . They understand that human reproduction is not an efficient enterprise and do not go to pieces when the IVF cycle fails.

Most IVF clinics are extremely stingy about providing patients with information about their medical treatment. They seem to take the approach that patients are stupid and will not be able to understand anything about their IVF treatment because it's very complex ! Some don't even bother to provide a treatment summary - while very few provide photographic documentation of the embryos.

We routinely provide our patients with photos of their embryos . Making embryos is the heart of what an IVF clinic does and we take pride in our work ! This is a tangible end point I can deliver and seeing high quality embryos reassures the patient that they have received high quality medical care - and this helps to build patient loyalty. Many will frame these photos and use them to start their baby's album !

Educating our patients is an investment in helping them to achieve peace of mind that they have received high quality medical care, so that no matter what the final outcome, they know that they have had their best possible chance at having a baby by taking treatment in our clinic !

I was watching TV late one night , into the wee hours of the morning…

I was so tired & bored that I started channel-surfing and I stopped on this program called “70&Pregnant” on the Discovery/TLC Cable Channel. Boy! Did it wake me up? Mark & I have tried for years to get pregnant and we realized about 15 years ago that because of my premature ovarian failure, only a donor egg would work for us. So needless to say when I saw this program, I perked up immediately…. On this program, they featured an Indian doctor who helped a 70 year old Indian lady get pregnant and have child with a donor egg. The donor came from a nearby Indian village & the cost was cheap by U.S.A. Standards for IVF.

During the program, the doctor discussed the cost of IVF in Indian and immediately, since fertility treatments for me & Mark are too expensive, when I heard the cost of IVF in India, I jumped up & started researching Doctors in India right then and there. I could barely sleep that night.

When I woke up the next day, I went straight to the Indian Embassy here in D.C. – no appointment, no announcement, nothing…. and just talked to whomever I could about the country. The receptionist was the sweetest and kindest lady in the world. She told me so much about the country, the time differential, how to dial abroad, etc. Then finally I asked, hey do you have a science or medical representative here from India as a part of your staff? She said yes and she directed me to the Counselor of Science for the Embassy. He happened to be free, praise God, so he & I chatted for about 20 minutes. I was so excited about the cost of IVF in India that I didn’t even beat around the bush. I told him exactly what I wanted and he poured out all the information he could. He bent over backwards to help me.

He told me, if you are going to India and you don’t know of a Dr. I’d recommend Dr. A. Malpani. I keep hearing their names and I’ve read extensively on them & their practice. I’m told they are the best in Mumbai. You can’t go wrong with them. They have a lot of good write-ups and in my field, this it he name that comes up when referring to IVF in India. This was a name he had in his memory. He didn’t have to ask anyone or call anyone. This made me feel really good because how many people have an IVF specialist’s name at the tip of their tongue just waiting for someone to come in and ask for it? Then he introduced me to the media and newspaper staff, I had tea, then walked around and met other staff who gave me DVDs, Maps, CDs, Newspapers, Hotel contacts, etc. I was even put on the Embassy’s newsletter’s mailing list for events. The folks at the Embassy were the most pleasant people in the world to deal with. They took all my concerns about traveling abroad to a country where I didn’t speak the language away instantly. They also told me that they would help me an in any way they could in the future.

So I went home, armed with all this good literature, DVDs, CDs, etc. and started researching on the internet and made contact with Dr. Malpani. This was in June 2010. I’ve asked Dr. Malpani questions weekly if not 2 and 3 times a week since June 2010 about IVF, donors, his/her practice, policies, procedures, etc. I’ve inquired about things on the internet, things I’ve heard, etc. and within a 24 hour period including Saturdays, Sundays and all holidays, Dr. Malpani’s answered my questions. I’ve even asked Dr. Malpani about questions that if I knew a little more about the internet I could have found on their web site, but Dr. Malpani, pleasantly & patiently answered them for me anyway.

While over the last 8 months of speaking with Dr. Malpani I’ve come to trust and value the practice, there was only one issue that held Mark and I up from flying to India and seeking IVF treatment immediately. We needed to find a donor that we could see & visually approve of 1st hand before the IVF procedure. Most doctors in India do not allow the recipient to see photos of the donors prior to the IVF treatment. Dr. Malpani’s practice is to match a donor to you and choose the donor anonymously. This didn’t sit well with me & Mark because while having a healthy donor is primary to us, it’s also important to us to see from whom ½ our baby’s identity will come.

After we told Dr. Malpani this, the option of advertising for our own donor was suggested. So we set out to find a donor by advertising in the local papers and on the internet. Dr. Malpani warned us to be patient, that it could take some time. So we placed ads in newspapers in India. We’ve even gone to Donor and Surrogacy Agencies and it’s been a world-wind experience.

We’ve spent about $2,500-$3,000 U.S. dollars on several newspapers, internet services and donor agencies just advertising and viewing photos. While we aren’t happy about the cost, we are delighted that we’ve seen the photos and chosen to see our donor. It’s renewed our resolve to see our donor no matter the cost or length of time it takes to find just the right one.

In the meantime, let me tell you what we’ve experienced while searching…Oh MY GOODNESS! We’ve had men tell us they could provide us with eggs. We had to explain (via email) so many times that men aren’t born with eggs that we just decided to come up with a “cut & paste reply” to all those emails from men that answered “Female Egg Donors ONLY please Advertisements”. Then during our 2nd newspaper, we had men tell us you really need sperm & not eggs, let us supply them. We’ve had people email us nasty comments about what they think of science and what we are doing. Of course we deleted these and moved on as if they were never sent. We’ve had husbands respond to the ads & lie to us about their wives ages only to have the wives tell the truth later when we indicated that official birth certificates and Indian govt identification would need to be submitted to verify the accuracy of the age of the donor. We’ve had people treat us like an ATM because they knew we were calling from the USA and quote astronomical prices that multi-billionaires wouldn’t pay for golden eggs. We’ve had people tell us since we weren’t Catholic they couldn’t supply eggs after they answered the newspaper advertisements. We’ve had husband tell their wives no after their wives answered the advertisement. We’ve had people play really high priced negotiation games with us until we realized that they might not finally give up the eggs or would possibly hold them hostage if we dealt with them. We’ve had people call us back weeks later asking to donate for our original offer, after they realized we never called them back to offer a higher price. We’ve had people offer us eggs if we could guarantee them a job and flight over to the USA. You name it, we’ve had it. Most of it has been funny because we are committed to not get frustrated but I’d be lying if I said it wasn’t getting old at times.

All of this had us thinking once or twice…do we really want to try to find our own donor? Do we really know what we are doing? Then we’d go back and look at some of the photos and say, yes, let’s keep plugging along. Then when we finally were so tired and ready to give up & take an emotional break, the most stunningly beautiful donor replied to our advertisement. She was nice, well educated and seemed to be quite stable. Once we discussed the process, she said oh no. So here we were thinking we landed a donor, only to be stressed out with her back & forth fear of medication-taking, injection phobias and overall paranoia about egg retrieval. While we understood her lack of knowledge about what was required, we were drained emotionally by the process of trying to explain to her what was expected. We also found ourselves perplexed as to why she’d answer an advertisement when she should have expected that at least 1 needle was involved somewhere along the process.

Eventually we told her that this was more stressful than we could endure and we declined to continue further. She came back and said she was willing to think about it again once she had verified the process with Dr. Malpani. So she eventually spoke to Dr. Malpani and finally bowed out one last time. I must admit, I didn’t do a good job of telling her about the medications. I was too honest and this was best something left up to a Dr. to explain because just listing them out is scary to someone who’s not seeking a child and just wants to help, even if it is for monetary gain. I should have thought about that before I blurted out all the medications and injections. I now know it’s best left to a trained physician to tell patients about stuff like that.

So in the end, Mark & I knew it wasn’t meant to be so we didn’t get too upset by her resurfacing only to bow out one more time. We believe what’s meant for us is meant for us and will come our way without a bunch of coaxing and cajoling.

So we continued to plug on. Then Dr. Malpani suggested egg sharing. We were elated with the option but then we ran into a road block when the only person who has offered to share her eggs wasn’t of Indian descent. This mattered greatly to us because of my heritage so we again, prayed about it, declined that egg sharing opportunity and are now moving forward.

So, 8 months later we are still looking for an Indian egg donor. We’ve put our IVF plans on hold until we either find one through an agency willing to allow us to pay them a referral fee and use their donor or until we locate a donor whose photo we approve of. Most practices aren’t interested in sub’ing their donors out so this may result in us going back to the newspapers for more advertising.

Mark and I’ve talked about this until we are blue in the face. It’s most important for us to have a healthy child. But it’s secondly (not equally) but still important to us to have a child that looks like me as much as possible or like she/he could have been related to someone in my family, even with ½ of my husband’s DNA injected in the mix. Because we’ve located two women who fit this bill but who bowed out because of (a) fear of the procedure to extract the eggs and the 2nd because of a family and medical emergency, we’ve decided to press on because we now know that in a country of over 5 Billion and in a city like Mumbai of 22 Million, she’s out there. We just have to be patient and allow God to deliver her to us.

Traci & Mark.

trbrown1@yahoo.com