IVF has now become the "final common pathway" for treating infertile couples. While IVF treatment can be expensive, being well-informed about the IVF procedure can help you maximise your chances of having a baby. You need to learn about IVF success rates, IVF risks and IVF complications, as well as the IVF drugs and IVF medications which are used during the treatment cycle, so you can find the best IVF clinic for your treatment.
In Vitro Fertilization (IVF) is an extremely cost-effective treatment for most infertile couples, and allows us to do in the IVF lab what is not happening normally in the bedroom - no matter what the medical problem may be !
You can read extensive details about IVF in the Chapter on IVF in our book, How to Have a Baby.
If you have done IVF at another clinic, have you got upset that a different doctor attended your procedures each time? Are you forced to talk to a number of different nurses, with no real direction ? Are you having trouble getting the feedback or explanations you need ? At Malpani Infertility Clinic, all the treatment ( including the consultation, all the Ultrasound Scan, Egg Collection and Embryo Transfers are done personally by either Dr Anjali Malpani and Dr Aniruddha Malpani). The buck stops with us - and we don't delegate any part of your delicate and critical IVF treatment to anyone else !
Our pregnancy rates are very high, because we can transfer more embryos in difficult patients ( unlike clinics in UK and Australia, where the number of embryos which can be transferred is limited by law). While transferring more embryos does increase the risk of high-order multiple pregnancies, this risk is negligible in difficult patients ( for example, the older women or women with previous failed IVF cycles). In our clinic, we customise the number of embryos we transfer for each patient we treat, rather than just blindly follow a guideline ( which has been laid down for the general population, without considering each individual's specific problem).
Our equipment is state of the art and is sourced from all over the world. For example, our CO2 incubators are Nuaire incubators from USA; our stereozoom and inverted microscopes are from Olympus, Japan, and our ultrasound scanner is from Aloka, Japan. We use IVF catheters from Rocket of London, UK; ICSI pipettes from Cook, Australia; the Saturn laser unit for embryo biopsy and laser assisted hatching from Research Instruments, UK ; IVF culture medium from Vitrolife, Scandinavia; and IVF disposables from Becton Dickinson, USA. Our IVF lab complies with international standards and guidelines.
Coming to Bombay (Mumbai) for IVF is extremely easy ! Bombay (Mumbai) is a major metropolis, and has its own international airport. The Infertility Clinic> is in the heart of south Bombay, and is an hour's ride away from the airport. IVF treatment is done on a day-care basis, so you do not need hospitalisation at all. There are many hotels nearby. You only need to make 4 - 6 visits to the clinic during the entire cycle, and after the embryo transfer, you can fly back home !
This is the protocol we use for performing IVF.
The following preliminary tests, to check the quality of eggs, sperm, uterus and tubes, can be done locally with the help of your gynecologist.
- Semen analysis for husband
- Blood tests for wife ( Day 3 - FSH, LH and PRL, TSH and AMH ). SRL and Metropolis Labs both have a network of collection centers all over India, and are very reliable.If you are in the US, you can do this at www.mymedlabs.com
- HSG ( hysterosalpingogram) for wife
- Vaginal ultrasound scan for wif. The vaginal ultrasound scan on Day 10 or 11 should check for the following.
a. ovarian volume
b. antral follicle count
c. uterus morphology
d. endometrial thickness and texture
Please email me these reports to confirm they are normal. You can scan them in; or just summarise the values.
The actual IVF treatment starts from Day 1 of your cycle, when you start taking Inj Lupride ( GnRH analog, manufactured by Sun Pharma , 0.2 ml subcutaneously daily. I vial contains 4 ml and will last for 20 days. Alternative options include Lupron
( for patients from USA) or Synarel or Nasarel Spray; or Inj Decapeptyl Daily.
You then need to do a vaginal ultrasound scan or E2 ( estradiol) blood level on Day 3. Specialty Ranbaxy Labs and Metropolis Labs both have a network of collection centers all over India, and are very reliable. You can do this locally in your own home town.
If the scan is normal ( no cysts in the ovaries, with a thin endometrial lining) and / or E2 level is less than 50 pg/ml, you start superovulation with HMG injections ( gonadotropins, Menogon , manufactured by Ferring ). Alternatives include other brands such as Pergonal, Metrodin, Follistim or Gonal-F. Our standard dose is 3 ampuoles ( 225 IU) IM for patients less than 35 years of age; 2 ampuoles ( 150 IU) IM for patients with PCOD; and 4 ampuoles for patients more than 35 years old.
You need to come to Bombay for a scan on Day 10; and then do alternate day scans. Your husband only needs to join you on Day 14 for a day or so ( or you can hand carry his frozen sperm sample).
This is what a typical daily schedule for an IVF cycle looks like.Day 1. Inj Lupride, 0.2 ml sc. ( Downregulation starts)
Day 2. Inj Lupride, 0.2 ml sc.
Day 3. Inj Lupride, 0.2 ml sc. Vaginal ultrasound scan to confirm there is no ovarian cyst. If there is no cyst, we can commence superovulation.
If there is a cyst, we aspirate/ puncture it under ultrasound guidance and continue with the treatment.
Day 4 Inj Lupride, 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM. Superovulation starts.
Day 5 Inj Lupride, 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 6 Inj Lupride, 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 7 Inj Lupride, 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 8 Inj Lupride, 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 9 Inj Lupride, 0.2 ml sc. Inj Menogon ( 75 IU), 4 amp IM
Day 10. Come to Bombay (Mumbai)
From Day 10 onwards, patients need to continue taking daily injections, but are free to see the many delights Bombay has to offer ! You can also take a 2-day trip to lounge around the sunny beaches of Goa and/or see the famous Ajanta-Ellora caves.
We do not monitor E2 levels routinely, so you do not need daily blood tests (we don't treat our patients as pin cushions!)
As a result of our simplified protocol, out of town patients can start their superovulation in their own city, and need to stay in Bombay for only 8-10 days, if you have a cooperative doctor in your hometown. We also provide inexpensive accommodation facilities for patients in the clinic itself for a short stay. This is especially useful when wives need to stay alone in Bombay. There are a number of hotels nearby which offer comfortable boarding and lodging as well.
You can book your tickets online, and find the best deals by asking Indian travel agents in your city. A return air ticket to India from the US costs about US $ 1000-1500. Your husband can accompany you, or you can hand-carry his frozen sperm in a dry shipper . To do so, you need to borrow a dry shipper from your local infertility clinic.
If you have failed IVF in the past, we can use advanced technology to maximise your chances of getting pregnant.