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Second opinions for IVF patients
While second opinions can be quite helpful in reducing " avoidable medical care" , they come with their own set of challenges. . Patients are scared about seeking out a second opinion because they are worried that by doing so, the doctor who is treating them will get o...
How many IVF cycles will it take for me to get pregnant ?
There are some questions which IVF doctors cannot answer accurately, and one of these is the commonest questions patients ask - How many IVF cycles will it take for me to get pregnant? Patients know that IVF doesn't have a 100% pregnancy rate and that th...
Why a picture is worth a 1000 words in an IVF cycle !
This is why patients should always insist that their IVF clinic provide them with photos of their embryos. This helps to keep the IVF clinic honest ! Good clinics provide embryo photos routinely and proactively, because they are transparent, open and accountable. Sa...
Root cause analysis for IVF failure
We treat lots of engineers and computer programmers who are infertile , and when their IVF cycle fails, they ask us, "Can we please do a root cause analysis to find out why the cycle failed?" After all, they are engineers and think logically and analytically....
Overdiagnosis in IVF - how some IVF clinics increase work for themselves.
Lots of IVF doctors are very trigger happy, and make a diagnosis which is completely inaccurate. For example, they will do an ultrasound scan for a patient on the fifth or sixth day of the cycle and notice at that time that the follicles are small or the endometrium...
Why do IVF doctors sing a different tune after the IVF cycle fails ?
Patients who have failed an IVF cycle often find that what their doctor told them at the time of the embryo transfer is very different from what they tell them after their IVF cycle fails. At the time of the transfer they are very optimistic , and gush about how g...
How over-reporting on ultrasound scans harms infertile patients
Vaginal ultrasound is an extremely useful tool when evaluating an infertile woman, but it often bothers me because there are some sonographers who over interpret the scan images. Now, I like the fact that they are careful and systematic, and document everything they...
Why freezing all embryos is the IVF treatment of choice today
You can read the full text of the paper in Human Reproduction at https://academic.oup.com/humrep/article/33/5/924/4925329 It's chock full of medical jargon, but the message is quite clear ! Abstract STUDY QUESTION What is the chance of having a child followin...
The right way to do a HSG
The problem is that most X-ray clinics do a very poor job at taking a HSG , because they try to cut corners. Many radiologists are not comfortable doing a vaginal examination, and are quite clumsy at performing the HSG. Even worse, they only take 2-3 films, and don'...
How doctors cause harm
A patient sent me this email. Hi doctor my wife had two miscarriages in last 18 months . After second miscarriage we have done TORCH test, it shows high range of of CMV IgG at 200 (normal range is 0-6) and CMV IgM is non reactive range (0.17) we had consult doctor h...