let it go to the dogs !!

It is a doggy story from beginning to end.Nothing about women or health or infertility.
Due to multifactorial reasons I got enrolled for my first 10 kms run scheduled for september 2016-Pinkathon ,Delhi.
The person who initially in 2015 had suggested me to try running,by that time had changed priorities.I had thought he would guide me so called training for long runs,never being an athlete or sports person.I was left with the option of trying it myself or run with the local running group,the timing of which was too early for my comfort.Being a late sleeper ,I needed my 8 hours of sleep an 5 am runs were not healthy at all for me.Other option was to quit that 10 kms.By God's grace I haven't quit anything which needed my solo participation.
I started with walks and to my amazement I had run my first 10 Kms in not too bad timings.But that run is a different story all together.I used to train and practice in my condominium myself,all by myself and You tube videos to guide.4 stray Indian dogs have been adopted by our condominium mates and they mutually co exist with us.
When I used to run,mid way around half the circle,4 of these dogs used to come along with me,join ,lick and pounce and play and do all what they could do to show their affection.It was annoying at first and slowly i got used to it.It became the daily routine.Why they liked me,I still don't know as not even once have I played with them or given anything to eat.
And then 20th November was Airtel delhi Half Marathon.My first 21 kms.Again I was alone to train.My friend has his own priorities,other friends who needed help and moral support and training.Anyways again these four guys followed me everyday at the same pace as mine.If I used to run they used to run .My walks made them slow down their pace.They had become my friends ,who derived pleasure of my company.For them no other gain from me mattered and neither I was of any use to them except occasional chats we would have on the running tract.
Now I have a pedigreed Beagle at home.Son of parents who have been show dogs and prize winners-Buddy.A nice little content four years old.Suddenly I was finding a change in his behaviour.He was ignoring me.What was the reason?And then we realised that all the family members used to give him some prize food as soon as they entered the home while I didn't as the deal was not to over feed him to improve his longevity.I felt bad.You can interpret me as a mean person who feels bad of a dog's behaviour or you can classify me as a person who is sensitive enough to feel bad even of a dog's behaviour.And I did rebuke him.
When I came down to run that  day,for the first time I realised the unconditionality of the love these stray dogs had for me.Why?I don't know but their friendship had nothing to do except for being with me for those hours as we were together.I was touched and now we are friends.I look forward to meet them when I go running and in their company I did my first 21 kms.I have patched up with the pedigreed Buddy by offering him his goodies off and on but what I value more is the friendship of street dogs ,who made a runner out of me.

Power of Positivity

My biggest handicap while writing this blog is my limited Vocabulary ,having studied in a non english medium school and have little what so ever liking or time for non medical books.(Inspirational ones are the only exception)

How many of you trust,what you do gets back to you like a boomerang?All,many or nobody?

Well,I do believe in it.As after all whatever you  will sow,you will reap.I have many personal reasons to believe it and I will share with you guys in due course of time.

I reached my OPD Chamber and there was a middle aged couple chatting with my Assistant Ankita.Ankita told in her typical way the medical history where she weighs every word she speaks carefully, weighing each and every word . After all I am the boss.Ok so this 46 years old Lady wanted a Hysterectomy today.Period!!We will call this lady K hence forth for the sake of convenience.

K is a govt teacher ,travels everyday 128 kms towards Rajasthan and comes back.She had not taken a single leave in her career of many years ,she told me proudly.I was impressed ,no doubt.For her 46 years ,she looked younger.It would have been easier to accept her asA 35 year old.A chatty female,who was in rush not just to get a surgery done but also to tell a lot of related stories.Her husband was the scared  and quite one.Scared ,if he would be able to run this show all by himself i.e getting his wife operated and manage the home too.

K had been diagnosed with a big fibroid which in my opinion she could have lived further.But she was determined...surgery,surgery and surgery as that too ASAP.Advised to get endometrial biopsy done preoperatively and she said 'no'.Okay so the next day she was taken for removal of uterus and we decided ( what me...all decisions were of K and I was just executing it)to preserve the ovaries as everyone in her family gets menopause after 60 years of age only.

Do You know me or my professional profile?No came the answer pat.And you are in urgency to get a major surgery from me?Doctor,a neighbour told go to Artemis and in Artemis we liked your name best .I do loved my name before,and I love it more now.Thanks Mom and Dad for the same.I thanked her but said my name kind be the only thing.She said,it gives me positivity.Then came the bouncer.

She said,'Even God has to show his face to us and not just vice versa) .As I have not harmed /hurt or professionally did any misdeed/I don't think a reason to be in  wrong hands.What face will he show to me?Her word were even re assuring for me.It always helps the doctor to treat her patient better if the patient shows so much confidence in the doctor.
It was a complicated case with adherent bowl and bladder due to previous multiple abdomen Surgeries.The surgery went well and uneventful.She visited me again in OPD.So full of praises for all of us but mostly her husband who according to her had graduated to being husband rather than a scared companion of past.

While leaving she again said.God had to show his face to me.That's why I met your team.I didn't do any online search and once I had talked to you the vibes told me-Go for it under her and no where else.

The theory of The secret says,what ever you you wish with full heart the universe conspires to make it happen.I have seen it happens.You are guided rightly by your circumstances.A believer is better than someone who has done mega research on the doctor on internet and still isn't able to trust the person in whose hands has put her life.

Being working in a ECS empanelled hospital,I do get wives of senior level Army officers off and on.It is a huge concession for them.Now this lady , say R,needed a surgery which went smooth again.She came in follow up and just notice the difference in K and R's behaviour.She is a non believer,it sounded.She said doctor I have to say everything went well.I am not even sure you did any surgery on me,as I feel really comfortable.And yes...this is exactly she meant.
In my personal life I have seen power of positivity.It works.In each and every sphere of life.Only-Trust,believe and when things go against you still have Gratitude for a while.And you will realise....everything is back on tract once again.Usko bhi to much dekhana hai !! :) :) 

Poor Responders in IVF

Few Problems in IVF are more frustrating than a poor responder to Gonadotropin stimulation.
The commonest causes are advanced age and also Ovarian Surgery.Let me inneumrate it for ease of understanding

• Advanced Fertile age.The fertility goes a steep downhill after the age of 37 years.
• Previous Ovarian surgery
• Severe endometriosis
• endometrioma
• Obesity
• Previous pelvic adhesions
• Previous pelvic infections
• Smoking
• Previous chemo/radiotherapy.

Though there are many definitions of poor responders but the most widely accepted one is < 3 Oocytes retrieved despite maximal stimulation.An AMH , 3 Pmol/l or an antral count of < 5.
( One can't stimulate follicles which aren't there).

There are various so called treatment options for Poor responders but only testosterone patches and Letrozole have been used with some success.Unfortunately Letrozole is still not accepted as a fertility medicine in India,once it was withdrawan following the Canadian controversy.DHEAS has also been recently attempted to help the poor responders.

One is tempted to use Gonadotrophins at higher level in such patients as a starting dose 

Oh so famous

People ask me how is the settling down back to Gurgaon.And my answer is slow and steady. Well yes, exactly that is what it has been.

When I was about to join Artemis Hospital,there was continous enquiry at our call centre as if every pregnant Lady in Gurgaon just wished to shift over to me.But no...this isn't how things work.That was just initial frenzy.And it has settled down quite a bit.

I do get patients,every day 2 to 3  new ones ,who already have heard something positive about me .But yes it isn't a busy clinic by any standards ,certainly not by the standards I left it in 2014.So the upside is that I get plenty of time to talk to these patients and their families and their kids.All are happy and I enjoy the chats just like I used to do so in 2007 when I started initially in Gurgaon.

But today I was surprised.The patient who visited in my clinic ( she was following my India return ever since she got shifted to Gurgaon) is actually my tower mate and we live just 1 floor apart.And she had no clue.This much for my socializing and advertising.

As if this was not enough for me to feel bad about my anti social nature and lack of PR.another gentleman whom I met in my building lift and on knowing my name asked-Kaushiki,the famous Kaushiki Dwivedee,you live on this floor.Heard so much about you seen for the first time.Now tell me,wasn't it enough to make me feel so bad about my PR skills.

I don't have as many patients as I would like to and their are people who are trying to trace Kaushiki Dwivedee out.Need to do something fast.

Marketing.New paper ads!!Any suggestions?

Miscarriage and Progesterone ( To prescribe or not to prescribe)

This Miscarriage and Progesterone will be as pertinent to me whether I am donning the role of an Obstetrician or of an Infertility specialist.I am sure you know of some one had miscarriage.It is a very common process in pregnancy( as common as 1/4th Pregnancies would end up in termination).Why it happens?99 % as the Pregnancy is unhealthy and nature is trying to save you as a parent and the foetus if it survives undetected from the miseries to follow on birth.So is miscarriage a cause of sorrow or relief?? ( I would come across as ruthless,insensitive person giving such a statement.But this is a fact and how much hard I try to sugarcoat it,facts and statistics still remain the same)

In India ,it is a common practise to get Progesterone levels done,declare that there is a chance of miscarriage and start Progesterone or many times HCG injections.So many times it is done just routinely,randomly to 'prevent a miscarriage'Can miscarriages be really prevented,unless they are recurrent miscarriages where there are some factors in mothers body which isn't allowing a healthy foetus to grow?Or it is a late miscarriage due to incompetent cervix where 'a stitch in time can save nine'.If your gynecologist thinks she can prevent miscarriage by a shot of progesterone,probably she/he can but there isn't a scientific evidence to it.Good part is that Progesterone doesn't harm you or the foetus ,so don't worry even if you are on it.You wish to stop it or continue it,it is up to you.If you are my patient,I will explain you all these details but won't prescribe from my side unless you ask for it.

So is progesterone helpful.Yes it is in IVF conceived Pregnancies where Ovary has been suppressed by medications and there isn't proper formation of corpus luteum due to artificial intervention in the process of conception and after cerclage of cervix.I will write about usefulness of progesterone in one of the posts.

For those who wish to read further please follow this link
http://www.miscarriageassociation.org.uk/information/research/the-promise-trial/

IVF Specialist-When you got to sleep ,you got to sleep!

Many a times I have been asked this question-What made you leave your flourishing practice and leave for Australia.And every time I come out with an answer which I feel was the probable reason.But I think the most important reason was deprivation of sleep.Yes,that is true.Readers ,I am sure you all are aware that medicine is a demanding profession.Without going in the data collection of which study shows what about in which country how many hours do the doctors sleep,it is a known fact that a doctor practising Obstetrics is sleep deprived.

In 2007 when I started my private practice ,totally new to Gurgaon and for that matter even Delhi,I had a zero patient base and then it improved.The numbers of emergencies( mostly deliveries) were limited.And conducting a vaginal delivery be it Normal,Vaccum or forceps used to give me an ultimate kick(More techniqualy difficult,more was the kick).......much more that elective gynaecology surgeries including Laparoscopy surgeries as well as uro gynaecology surgery which I was quite comfortable with even then - with what Dr Plemming and Dr Klazinga had taught in United Kingdom.

Slowly by God's Grace the practise improved and so did the number of deliveries.By 2014 ,I was awake almost every night with routine OPDs and OTs as scheduled.There were times I would reach delayed for OPD,with not so happy patients who had their appointments delayed by an hour or more already as I was stuck in Labour ward trying a vaginal delivery.7 years of Obstetrics was taking it's toll.I was still maintain the WHO approved 80 % vaginal delivery rate but that Kick was gone.It was a job ,no more a passion.And when I don't enjoy something just like any other human being I loose interest.It was making me cranky,irritable and bored.Increasing Number of patients didn't excite me any more.It wasn't healthy for me.

And then was the Option to take a break.Move to Australia.Have more regulated hours of work.The famous Work life balance.It was enthralling and rejuvenating. 2 years break helped me a lot.

And then is when I thought,if I wish to have my sleep and at the same time not increase my Caesarean section rates and sleep with a clear conscience.When I know that I didn't use early decelerations as and excuse of foetal distress,when I know that a high head of baby is genuinely a high head of baby when I call it a caesarean, when a thin meconium at 8 cms is no indication for a caesarean

section,I need to reduce the Obstetrics component of my private practise.Very Honestly it wasn't just the love of IVF,treating infertility and the money involved but most importantly ,trying to switch over from a totally unplanned life of obstetrician to a more routine life of 9 am to 5 pm.

Now after reading this post,if you have a question,why did I return back,I am not surprised by your query :) :) Perhaps 2 years from hence I will tell the real reason of my return too ;-) ;-)

Tushar Kapoor-single parent Surrogacy (What do you say) ?

#Tushar Kapoor becomes a dad , came as a surprise to many.First of all congratulations to him and his whole family.And as I clicked on the net to find some juicy gossip about a possible clandestine affair,it turned out to be interesting,informative,bold,unconventional and thought provoking piece of news.Single parent surrogacy!!

Not long back some one wanted to know the rights of single males to opt as an option for surrogacy#.The Indian Law allows an Indian female or male to opt for surrogacy legally.If you are a foreign national ,then you can't get it done in India legally.

The legalities associated with surrogacy is complex world over with no uniform law.India is one such country which allows the intended parents the legal rights by virtue of the contract signed by the surrogate mother.

Those who are curious about how can a male be a single parent..A male can have a Ovum donor,a surrogate mother and his sperm and take help of an # ICMR certified centre to go ahead with a surrogacy.

Single parent surrogacy has many ethical issues.There can't be a right or a wrong answer to them.Here we are taking care of an individuals right  and instinct to have child but at the same time it is also pertinent question.....what about the child?Is it in the larger interest of that child.I am no one to judge and would invite the readers to pour in their comments.

Same sex couples can't have children through surrogacy but if single parents can then obviously there can be loop holes which same sex couples can use to satisfy their parental instincts.And moreover it doesn't make sense either to deprive them of that instinct(but then in India same sex couples will have to wait to get it done legally till it is approved by our judiciary.

Doctor : Please give me a twin.( Can I...May Be I can)

I am an attractive looking female in early 40s.Look younger than my age :)
Still I keep on asking my husband to perform a weight loss surgery on me when he shows me the pictures of people who were Obese and lost many kgs following a Bariatric surgery.I get annoyed and depressed at times or mostly.Being skinny was never my lives aim but to have toned body,6 packs ab and sun kissed skin was.And for a while I think he is giving unfair advantage to his patients. They are more uncontrolled and thus they can have surgery while I am thinner...I have to work hard to get my dream body.

And then comes a lady to me or rather two.Both have one prior baby and they ask me to perform an IVF on them to give them twins.They have got pots of money at home and they wish to have children who can enjoy.Fair enough.Demand is valid.Isn't it?Both these women are my ex patients and I am myself amazed how i managed to conduct so many vaginal deliveries in past.I am impressed by myself.

And I sit down thinking but fertility isn't an issue,how can I perform an IVF with desire to  have twin Pregnancy as an indication?And she cajoles me.Doctor it will be a great help and you know money is no issue for me.Ask whatever you want to.I trust you.And here I am ...she trusts me and how can I perform an un indicated IVF and how do I promise her a twin.The embryos might get implanted or they might not.I can't be so unethical as to put 4 or 5 embryos anyways and then performing the guillotine of reaming 2 or 3 with KCL.Even the Lady got horrified with this thought.Well she was justified in asking.I even got swayed for a while with her authentic demand and then the guidelines and ethics.So a NO.

And I know...no bariatric surgery.I need a personal trainer and not a Bariatric surgeon myself :) :) 

Freeze the future !! ( All about IVF)

Though there are many moments of my past which I want to vitrify and keep it frozen for ever,take it out once in a while thaw it,feel it and keep it back safely frozen.We all know freezing prevents early decaying or rotting.But this whole paragraph was just a weird imagination of freezing the moments.


Another scenario.A young woman visited for consult and told how young men aren't willing for commitment these days.And being human one ends up having sex with people who don't even commit long term.I could relate what she said with a similar condition in Sydney,where wealthy qualified Ladies in 30s couldn't find a partner to have child with as these 40 plus boys were interested in skate boards,cycling,maintain a physique and a half age trophy wife.


So what?So a very big social dilemma.What happens of women who want children and can't have as they don't have a committed partner or husband?or still further she has either but wants to defer pregnancy for a career she always dreamt of?


There comes the role of oocyte freezing.There are techniques by which the stimulate ovary is used as a site of oocyte retrieval and then the eggs are frozen for ages.Suppose a lady decides to get it frozen at the age of 30 years her egg
will remain 30 year old when she turns 40 years.And thus her  chances of conception by using that stored egg is same as that for a 30 year old lady and not 40 year old lady .Amazing...isn't it.

So if career is important or till you find a proper partner,you can cryopreserve your eggs and make baby when you really want.

And most important is the age of egg for conception.Implantation failures are really a rare cause,otherwise 72 years old won't be getting pregnant with IVF with menopausal uterus

then(of course by donor egg).

This whole process is a reality.I would advise all the young women stuck in a dilemma like this to come and meet me at my clinic and I can enlighten you further.I can even come to your companies to talk about this rather sensitive and important issue.

How Much Time Have I got Doctor?

It is not an uncommon question encountered by a routine Gynaecologist by Women in her 30s who wants to balance between a career and a family.Do we have an answer?Up to an extent yes but not certainly with a hundred percent certainty.

There is a hormone called AMH -Anti mystery hormone :) .Well this anti mystery hormone is actually called anti Mullerian Hormone.This AMH gives an idea of your ovarian reserve.It would not give any idea of the quality of hormone remaining but will comment on the quantity of ovarian follicles remaining at that particular time.Higher the AMH more is your ovarian reserve and probably you can wait few more years and vice verse.

AMH has other uses too.It is measured by Infertility specialist world over as the baseline which helps us in deciding the starting dose for Gonadotrophins for stimulating an IVF cycle or for that matter even IUI cycle.

Some interesting facts about AMH
AMH can be tested on any day of the cycle unlike FSH
It is higher in women who have PCOS simply because women with PCOS have at least 6 times more antral follicle than non PCOS women(even PCOS has something to cheer up about :) That is why in PCOS the risk of OHSS is more and your infertility professional is super careful about the dose of medication if needed for your ovulation induction.

But remember it the only mystery it clears is the amount of follicles not the QUALITY OF FOLLICLES,which deteriorates with increasing age. 

Love,stress and Dhoka (LSD)

Somebody asked me the other day.Doctor,why this sudden rise in abnormal children,Complicated pregnancies and increased conception with IVF?


Well the answer isn't too complex or complicated.Very straight forward.Even you can answer even if you are not a Medico.

The lifestyle has changed a lot in last 10-15 years.People fall in love and then get out of love and then again fall in love and get out of it , till  a women has reached in her 30s.Suddenly you realise the body clock is ticking away and you need to be in long term love and marriage too.(Indian community still is quite conservative.Partners aren't still so much in vogue as are the husbands).What ticks away are your ovarian follicles meant to be the eggs for ovulation and conception and baby.


You can exercise hard,you can get plastic surgery done,you can get office time shots of Botox and look half your age.But remember,you can't fool your ovaries which is loosing hundreds of follicle every month since your birth.And comes a point the quality of eggs remaining isn't of best possible quality,which increases
INFERTILITY,difficulty in conception,structurally and genetically malformed babies and increased rate of IVF Pregnancy or even failed IVF cycles.And that leads to stress,which anyways is no less already with all the approaching deadlines,pending assessments and probable promotions.A dream of moving to foreign land,decreased frequency of sex as it is anyways hampered by the hectic life of deadlines which both partners are living


And suddenly you feel cheated ( Dhoka) by the nature.While you were busy building your career ,Nature was busy stealing your oocytes or deteriorating it's quality.

Isn't the answer very simple and logical?

So do we stop building carriers?Absolutely not !! Do we have answers to deteriorating oocytes or depleting oocytes,a late age possible conception and still get good outcomes?Yes there is .Promise ....will try to give the answers in next post.But goes without saying....Natural way is the best without intervention of an IVF doctor like me.

Women Health: Patience is a Virtue -Ovulation Induction for IUI

Women Health: Patience is a Virtue -Ovulation Induction for IUI

Patience is a Virtue -Ovulation Induction for IUI

There is a friend of mine,who insists patience is a virtue,has compelled me to be patient and leave my quick fix ways.And I am inculcating the habit.Patience is a virtue in personal life,professional life and life of even the patients we treat.

As always my posts are all motivated by real life posts.In last one month I came across 4 prescriptions showed to me by patients who had come to me for a second opinion regarding their subfertility treatment.Except for one,all three had 8-9 follicles > 16 mms ,were already given 10.000 IU of HCG and were ready for a spontaneous conception or IUI.It can be dangerous.Really dangerous.Multiple pregnancies are no fun neither is OHSS.

In this post I wish to talk of how much is too much for stimulation in cycle meant to be an IUI(Intrauterine Insemination)?I won't site specific cases as I realise that way the patients reading the posts can identify themselves and might not feel too comfortable.

IUI is known treatment for
Mild Male factor infertility
Unexplained infertility

For Mild factor Infertility(I will disscuss what is mild factor in next post) with no female factors even an unstimulated cycle is good enough and there is no advantage of using clomiphene citrate or Gonadotrophins

For Unexplained Infertility stimulation with Gonadotrophin + IUI gives maximal percentage of success.(more than Gonadotrophin alone or CC + IUI).If treating unexplained infertility my first line of treatment would Gonadotrophin + IUI but one needs to be cautious about the dose.
AMH levels give a fair idea about the initiating dose for IUI as well as IVF stimulation cycle.
THE AIM SHOULD BE TO DEVELOP NO MORE THAN ONE BUT MAXIMUM TWO LARGE FOLLICLES.Any thing more than that increases the level of multiple pregnancy and it's complication significantly.One way of acheiving it is by giving low dose FSH for 14 days straight(Now you know why I remembered my friend?He has made me understand the virtue of patience) and if need be increase the dose another 37.5 for a week and give trigger when we have a nice follicle ready for it and plan IUI.

If bychance you have give gonadotrophin in a dose higher than needed....well recognise the problem.Either ask the patient to abondon the cycle.Or talk with the couple if they are willing to get it converted to an IVF cycle.with 6-7 > 15 mm follicles and a trigger of 10000IU HCG,she would be definitely safter with an IVF than an IUI.One can control the number of embryo transfer as well as prevent OHSS by sucking out the follicle and follicle fluid.

Uploads from Kaushiki Dwivedee

Digital Marketing-some points to ponder.

These days I for sure have much more time at hand than I am used to.Someone used to a heavy load of work,resetting the practise seems like a boring chore.

But every phase in life teaches you something.And I am amazed ,in last two years Indian Medical Practise seems to be totally taken over by digital Marketing.So many business ideas cropping out of it.Good isn't it?But is it?

Though I realized the potential of digital marketing long back in 2008 with website and a blog,even for me the current digital world looks so virtual to the extent of being disturbing.Fake likes,fake comments,fake feed backs and fake recommendations.

Doctors pay huge premium to remain in the top ten of certain sites.And then what?after 6 months or an year or may be two years or will they continue paying it for their whole life to be on top ten?And then what next?There will be a fee hike and their will be more new doctors in the 'market'.More competition. The will  to be in the top ten.And then fee goes higher .Doesn't it sound like a matrimonial site where you become a premium member and your profile comes first.I am not criticising it but then this concept doesn't sound healthy at all.In nutshell this kind of practise isn't a long lasting practise and would be controlled by the parent website.Clever idea but it has it's flaws as far as doctors are concerned.

Now a much more ethical dilemma.So the patient record is stored in the companies cloud.Which means people other than the treating doctor has access to the medical information of the patient.So what happens to patients confidentiality?I don't think the doctors who are using these services have thought about it.Well ....well ....the world has become a really chaotic place.May be I am getting Old and outdated :)

IVF India :-)

Am very busy trying to juggle things to settle down back to the India Grind.My pace of life is hundred times more and so is the rate of heart beat what used to be in Australia.But still I felt like writing this piece.It solves two purposes - Tells my blog readers of my upgraded skills and willingness to help them in infrtility treatment (not necessarily IVF).It doesn't mean that if I can Perform IVF now,all my patients have to have IVF only as treatment and also majority of subfertile couples are treated with simple helps like life style modifications,timed intercourse and help with ovulation.

Second and other important reason why I am writing it is my personal experience with Infertility treatment in India or for that matter world over.It has been the niche Sub specialisation which the people who have learnt it aren't willing to pass on the skills to others.It gives the IVF a mystical Aura.I have been a Lucky Girl and always blessed in life with teachers who took pride in teaching.My Prof a big name in IVF (I don't wish to misuse his name for my advertisement but at the same I hold him in so much regard I can't help but to mention him again and again) made it look all so simple scientific and logical procedure,that I am shocked that how the already existing 'infertility specialists 'make it sound like a rocket Science.OHSS,a deadly complication of Gonadotrophin happens when you pump the Lady with indiscriminate doses not realising the basis of starting  a particular dose in a lady......but that's why you need good teachers who can train you with the reasoning.

Second procedure Picking up the Ovum under Ultrasound Guidance-  of course not as complex as performing a Vaginal Hysterectomy.Much simpler.

Third is ET transfer.Very important step but it is not more complex than a pap smear,just needs some gentleness.

And so much of mystery ???

Paradox of the situation is many Unrecognized substandard IVF centres all over the India.Everyone trying to self learn as those who perhaps know the science better are not willing to teach it.

It is a Market.It is a business. Competition like any other Market.But then we doctors -are we only traders ???Is Money the only driving force?

And this is what I genuinely believe.It isn't a 'digital marketing' tactics.

What is a success?

Two years back when I left India,sale reps from a company Practo would come to me requesting to use there online services,Patient appointments etc.And I remember clearly telling the representative few days before I left for Australia-I won't need it for a while.He wanted to know the reason and I just smiled.And for two years I wasn't so aware of the the India medical digital marketing.Didn't need to.It was chilled and cool being a consultant in Australian healthcare system.You don't need to market yourself.You are assessed good enough to be a consultant by the college and you are as good as any other consultant .

Few days back in Artemis Hospital,one of my old patient visited me(Name not disclosed for confidentiality)I had delivered her first baby.Touch wood they were smooth nine months.This time Pregnant,she tried to find from Max Hospital,Gurgaon and she was told I was not working there any more. So,she looked for me in Practo. And she couldn't trace me there.And then she contacted few Other Gynaecologists before meeting me that day.Now if we leave alone the reason why she researched for me and how she located me etc. what I wish to say is-This is success.In two years this company has been so much of a success that a patient expects to find the doctor n Practo.If that isn't called enterprnual

Bemused Musings

Transitions are always perplexing.It looks just yesterday when I decided to move on to Australia.Make a new start.Explore the new system.Explore a new country and explore a new way of working.

2 years flew away in a jiffy.And again,no compulsions but I decide to move back to India.It looks as if I had never left.Same faces,same emotions,same hospitals.Everything is same but still it is a new beginning. Not as perplexing but still it is an effort.I have no words to thank the Artemis Hospital administration who is helping me in every possible manner to settle down .My colleagues,I must say have been very helpful and and kind.Small gestures but help a lot .

And my patients.Only 5 days of working and I have already met so many familiar faces.Can I thank God enough when they say-Thank God ,You are Back or it is so good to see you back.Really thankful for such kind words.

Restarting the clinic.Every single patient who has been my clinic patient has asked me the time frame.Am trying hard to put the threads together.So much to think and so much to arrange.Manpower or do I say woman power to  decor,all needs a fresh start.Pretty Confusing.After Chilled Australia a bustling India.

I know the musings won't be so confused very soon.

Update

I would be starting my IVF, Obstetrics and Gynaecology practice in India from 05/05/16 at

Artemis Hospital ,Gurgaon as HOD (Obstetrics and Gynaecology) and senior Consultant IVF

Please call /mail

Callcenter@artemishealthsciences.com or, call on +91 124 6767 999.
for appointments.

MY Clinic at Clinic Nirvana would be starting around 15/05/2016 as undergoing renovation currently.I would be updating the appointment number for the clinic soon.At my clinic I would be consulting only Infertility  and non Pregnancy Gynaecology cases.