HOW TO HAVE A BABY MALPANI INFERTILITY CLINIC TABLE OF CONTENTS PREFACE CHAPTER 1 Do you have an infertility problem? When to start worrying! CHAPTER 2 How Babies are Made - The Basics CHAPTER 3 Finding Out What’s Wrong -- The Basic Medical Tests CHAPTER 4 Testing the Man - Semen Analysis CHAPTER 5 Beyond the Semen Analysis CHAPTER 6 Diagnosis and Treatment for Male Infertility -- More Confusion! CHAPTER 7 The Man with a Low Sperm Count CHAPTER 8 The Latest Advance in Treating the Infertile Man CHAPTER 9 Ultrasound - Seeing with Sound CHAPTER 10 Laparoscopy -- The Kinder Cut CHAPTER 11 Hysteroscopy CHAPTER 12 The Tubal Connection CHAPTER 13 Ovulation -- Normal and Abnormal CHAPTER 14 The Older Woman CHAPTER 15 Polycystic Ovarian Disease (PCOD) CHAPTER 16 The Cervical Factor CHAPTER 17 Hirsutism -- Excess Facial and Body Hair CHAPTER 18 Endometriosis -- The Silent Invader CHAPTER 19 Ectopic Pregnancy – The Time Bomb in the Tube CHAPTER 20 Unexplained Infertility CHAPTER 21 Secondary Infertility CHAPTER 22 Empty Arms -- The Lonely Trauma of Miscarriage CHAPTER 23 Understanding Your Medicines CHAPTER 24 IUI - Intrauterine Insemination CHAPTER 25 Test Tube Babies - IVF & GIFT CHAPTER 26 Preimplantation Genetic Diagnosis - the newest ART CHAPTER 27 Using Donor Sperm CHAPTER 28 Surrogate Mothering CHAPTER 29 When Enough is Enough CHAPTER 30 Adoption - Yours by Choice CHAPTER 31 Childfree living - Life without children CHAPTER 32 Stress And Infertility CHAPTER 33 The Emotional Crisis of Infertility CHAPTER 34 How to Cope with Infertility CHAPTER 35 Infertility and Sexuality CHAPTER 36 Support Groups-Self-Help is the Best Help CHAPTER 37 Myths and Misconceptions CHAPTER 38 Helping Hands - How Friends and Relatives can Help CHAPTER 39 Rights of the Infertile Couple CHAPTER 40 Alternative Medicine: Exploring Your Treatment Options 1 HOW TO HAVE A BABY MALPANI INFERTILITY CLINIC CHAPTER 41 Making Decisions about Treatment CHAPTER 42 How to Find the Best Doctor CHAPTER 43 How to Make the Most of Your Doctor CHAPTER 44 Let the reader beware CHAPTER 45 The Infertile Patient's Guide to the Internet CHAPTER 46 The Ethical Issues - Right or Wrong? CHAPTER 47 How Much Does Treatment Cost? CHAPTER 48 Pregnant - At Last ! CHAPTER 49 Preventing Infertility CHAPTER 50 The Infertile Patient's Prayer and Infertility "Defined" CHAPTER 51 Making IVF affordable CHAPTER 52 Why are women scared of IVF? CHAPTER 53 Infertility Record Sheet CHAPTER 54 Self-Insemination CHAPTER 55 Interpreting the lab test results GLOSSARY 2 HOW TO HAVE A BABY MALPANI INFERTILITY CLINIC PREFACE Grappling with infertility is a lot like finding yourself trapped in a complex maze . You can't see what's ahead of you so you have no way of keeping your perspective . You wander the same path over and over again - totally lost and bewildered. You are alone with no one to show you the way out. There are many questions - and few answers. Which are the best doctors ? Which is the most effective treatment ? What options can be utilised so that the way out can be found ? This book is designed to give infertile couples a complete look at the infertility experience, to help them to negotiate their way through the maze as efficiently as possible. You need to find your own path - and this book will serve as a guide. Infertility is a problem that affects two people – and their whole family. It brings with it fear, anxiety, anger, guilt, grief - and in the end, hope. It's a problem that reaches deep into your emotional life and invades your emotional relationship. Infertility can steal away all your energy and attention. It can also require a great deal of time and money - and can demand total commitment. It may become your obsession. Confronting your infertility problem is a process that must be worked through - it takes time and effort. This book will show you that infertility is a difficult condition, but one which you can cope with and resolve. The most important message of this book is that you must be an active participant in your medical treatment. You are a vital member of your medical team - the more you understand, the better you can participate in the decisions that directly affect your life. Infertility can bring on a feeling of helplessness because you cannot have a baby when you want to. An important way of regaining control is by taking an active part in resolving your infertility by being well-informed. Why is it so important that you be well-informed ? Unfortunately, many infertile couples have had unhappy experiences, due to lack of information. 1. They may have a problem for which there may be an effective treatment but they may not receive this. Infertility for which there is no effective treatment is devastating, but infertility which is not correctly treated is the real tragedy ! 2. They may not have had the correct diagnosis made. 3. Their doctor - no matter how knowledgeable - may not be putting all the pieces together correctly for them. 4. They may be receiving treatment that is actually decreasing their chances of conceiving. 3 HOW TO HAVE A BABY MALPANI INFERTILITY CLINIC 5. There is a certain tolerance level which everyone has - and this limit may be financial, physical or emotional. Sometimes their tolerance may be exceeded before they receive appropriate treatment . Most importantly, being informed may make a difference in your getting pregnant . It can help you determine if your time, effort and money are being well spent. It may also help you to know when to quit trying . An informed approach will allow you to maintain control of your life, and will help you to realise that everything within your control has been done. And even if you don't get pregnant, you will at least feel satisfied that you fully understand your condition, and that you did your best. That knowledge will be your strength. This book can be read through from cover to cover - or you may refer to just a specific chapter, pertaining to your specific problem. We have deliberately allowed some repetition, so that chapters can stand on their own. It is not the goal of this book to teach couples to bypass the medical care they may need . On the contrary, the goal is to educate couples sufficiently so that they can find the right doctor, and as informed patients, participate in their own care. Our experience has been that the best patients are well-informed patients - patients who take an active part in their treatment, so that they can work with their doctor to develop an effective treatment plan. We hope this book helps to empower infertile patients, so that they can make the right decisions for themselves ! Dr Aniruddha Malpani, MD Dr Anjali Malpani, MD 4 HOW TO HAVE A BABY MALPANI INFERTILITY CLINIC Why a new edition for the new millennium? Reproductive technology has made dramatic advances in recent years – and pregnancy rates achieved with these techniques have improved considerably. This new edition , timed for the new millennium, has information on many exciting new areas, including: intracytoplasmic sperm injection, preimplantation genetic diagnosis, blastocyst transfer, cytoplasmic transfer, assisted hatching, egg freezing, and newer drugs such as the recombinant gonadotropins and GnRH antagonist. Many changes have occurred in other areas as well, and these have been included in this edition. The internet can help immensely in empowering the infertile couple with information, and we have included a chapter on how infertile couples can use the Net in order to help themselves. Many women are getting married at an older age, and quite a few are postponing childbearing in order to establish their careers. Infertility specialists are seeing an increasingly large number of older woman who would like to start a family , and we have included a new chapter on the special problems the older woman faces. We have also included a chapter on alternative medicine, and how couples can make use of this sensibly. Thanks to the media, many couples have become aware of advances in reproductive technology, which often make headline news. However, unfortunately, in the limited space newspapers and magazines have, they often provide a very distorted version. By focussing only on the success stories, patients often end up having unrealistic expectations of what the technology can offer them. This is why we have included a new chapter on how to critically assess newspaper stories, so that readers don’t get carried away. Unfortunately, infertility treatment has now become a lucrative small-scale industry in many cities – and patients are being exploited . Offering infertility treatment has become very remunerative – and infertility clinics are mushrooming in every town. There is a major danger of overtreatment, which is why it has become even more important for infertile couples to protect themselves – with information and knowledge ! We hope this book will help them to protect themselves, so that they can find the best treatment for their problem ! Dr Aniruddha Malpani, MD Dr Anjali Malpani, MD 5 HOW TO HAVE A BABY MALPANI INFERTILITY CLINIC CHAPTER I A Do you have an infertility problem? When to start worrying? "So, when are you planning to have a baby?" This is the commonest question most newly married couples in India are asked - sometimes even as soon as they have returned from the honeymoon! There is a lot of pressure on couples to have a baby, especially in traditional families, where the wife's role is still seen to be one of perpetuating the family name by producing heirs. Many couples still naively expect they will get pregnant the very first month they try (the result of watching too many Hindi films, perhaps!) - and are concerned when a pregnancy does not occur.