infertility centre delhi

10 Mistakes A Infertility Specialist

Prof. Abha Majumdar
Director, Center of IVF and Human
Reproduction Sir Ganga Ram Hospital,
New Delhi, INDIA

President’s Medal for best medical graduate of year1970-75
Award from DMA on Dr. B.C Roy’s birthday: outstanding contribution to
medicine,1999
Vikas Ratan Award by Nations economic development & growth society 2002

President’s Medal for best medical graduate of year1970-75
Award from DMA on Dr. B.C Roy’s birthday: outstanding contribution to medicine,1999
Vikas Ratan Award by Nations economic development & growth society 2002
Chitsa Ratan Award by International Study Circle in 2007
Life time Medical excellence award Obs & Gyne by Hippocrates foundation 2014
Abdul Kalam gold medal 2015 & Rashtriya Gaurav Gold Medal award 2017 by Global Economic Progress & Research Association.
Distinguished teacher of excellence award for PG medical education by ANBAI & NBE 2017 and Inspiring Gynecologists of India by Economic Times 2017. Felicitated by highest Merck Serono honor award at times healthcare achievers award 2018
Course director for post doctoral Fellowship in Reproductive Medicine by NBE, since 2007, IFS since 2014, ISAR 2014 and by FOGSI for basic & advanced infertility training since 2008.
Member of Editorial board of ‘IVF Worldwide’, peer reviewer for ‘Journal of Human Reproductive Sciences’, and member of advisory board for ‘Journal of Fertility Science & Research’.
Field of interest: Infertility, ART, Reproductive endocrinology, Endoscopic surgery for pelvic resurrection. and ART.
IVF Specialist Delhi

TOP 10 MISTAKES A FERTILITY CLINICIAN MAKES

The first principle of infertility management
Cause no harm
Infertility is not a disease
but a condition of life which is treated only by
choice
Underlying disease causing infertility may warrant treatment on its own merit and not because it is causing infertility

First error

Not to find whether couple really needs treatment!!!

Or is there just lack of LIBIDO?

Second error

Examination

Don’t forget to examine your patient!!!!
An USG or its report is not enough
(gives a good idea about coital practices, difficulties and frequency)
IVF specialist

Third error

Don’t be in a hurry to start treatment before establishing correct diagnosis

  • Tentative diagnosis on history only
  • Scope to change diagnosis and management if investigations show other wise

Unexplained infertility is the diagnosis of exclusion after having done all basic investigations

  • Unexplained infertility does exist in almost 20% of couples all over the world !! don’t label these patients with tuberculosis especially if their tubes are patent

Diagnosis

Establish approximate diagnosis before writing any medicine. 5 main areas to look for:
IVF Specialist Delhi

Ovary sensitive mind

  • Consciousness towards ovarian reserve but don’t panic
  • Don’t waste valuable time with poor reserve or older age
  • Give adequate trial with IUI in older women if married recently rather than resorting to IVF in panic of ovarian reserve
  • Don’t jump to oocyte donation unless one has tried conception with ones own oocytes especially in younger women

Fourth error

Prescribing loads of medicines

Lesser the medicines, lesser side effects & better compliance !!!!

  • First prescription no medicines except few definitive medicines as

– Progesterone withdrawal

  • Later prescription preferably only one medicine
  • No empirical combination of medicines such as: clomiphene with estradiol valerate, progestogens, steroid, ATT, vitamins and ayurvedic medicines (M2tone, speman forte)

Which is easier to follow?

Beware! Medicine cocktails may be dangerous

  • Cocktail of medicines: Don’t use

These may prevent pregnancy as combination of clomiphene with estrogens and duphaston may act as sequential contraceptive

  • Clomiphene Citrate: Don’t use in normally ovulating women

They may become further sub-fertile by CC’s negative effect on endometrial perfusion and thickness and perhaps also on tubal motility and cervical mucous

Principles of ovulation induction with gonadotropin

 

For treating clinicians

Stimulating for IUI :

Use smallest doses
50 to 75 units daily
Don’t use agonist or antagonist

For IVF specialist

Options for over stimulated patients:

Agonist trigger with

Aggressive luteal support with

progesterone+estradiol+hCG

  • Aspirate most follicles and leave only 2 or 3 and proceed with IUI
  • Convert to IVF

Don’t resort to testing & treatment of conditions not understandable

Fifth error

Availability of all methods of treatment under one roof will prevent bias towards one procedure

Fit your treatment into one of the standard treatment or a combinations within these

Beware of wasting patients money on non-specific drugs!!
These are expensive and the only good you do by prescribing them is to help pharmaceuticals survive on the cost of your patients.

Don’t decide surgical interventions because something needs to be done

Seventh error

Don’t take IUI lightly

  • Standardize the technique to give optimal PR so that bias towards IVF can be minimized
  • IUI gives a PR of more than 25% in unexplained infertility from well designed protocols to follow
  • Do not stop them from having natural intercourse before or after IUI
  • Be liberal in using gonadotropins if they give better pregnancy rates in IUI cycles

IVF from IUI is a big jump for the couple!…… not only cost wise but also psychologically because they know that if
IVF fails then there is nothing next

Eighth error

IVF

  • Treat your embryologist with the respect they deserve
  • Use standard conventional protocols for most cases (long agonist or antagonist protocols)
  • When a biochemical pregnancy is reported ensure it is not after hCG injection given prior to pregnancy test
  • Don’t give your patients luteal phase scare:

dr abha majumdar ivf specilist

Luteal support with progesterone is enough and if you want one more agent is okay (estrogen, hCG or GnRH agonist)

Ninth error

Don’t put your patients to rest / bed rest!!

  • Exercise improves metabolism and circulation, both of which contribute to better egg production
  • Regular activity also optimizes reproductive system by stimulating endocrine glands, which help eggs grow
  • Sweating out is a known stress reliever — a good thing, as stress significantly decreases probability of conception
  • Don’t stop your patients from exercising or having sexual contacts; if ART fails she still has a chance of getting pregnant!!!

Tenth error

  • Sexual intercourse is the only way to get pregnant naturally in case your treatment fails except in following circumstances:
  • In IVF cycles after day 7 of COS only if ovaries are big and hyper-stimulated
  • In IUI cycles one day before IUI if partner not confident of producing sample for IUI

Don’t stop sexual intercourse while treating infertility

How to improve infertility treatment and ART results?

  • Quality control and quality assurance is the key to success
  • Be open to criticism and change
  • Don’t be defensive of wrong practices
  • Feed back forms are a very important way of improvement

What is Successful Treatment

  • To have a single live pregnancy is successful treatment
  • Twins are failure of treatment
  • Triplets are disaster for the
  • woman and family both

    dr abha majumdar ivf specilist


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