At 42, a Mumbai businesswoman is hoping to be a mother the second time and choosing IVF (in-vitro fertilisation, where a couple’s eggs and sperm are fertilised in a laboratory before it is implanted in the womb) yet again. She was over 35 when she conceived the first time after 15 failed cycles, hanging on by a thread despite an emotional and physical roller coaster ride. “I am better prepared now and know that whatever I had corrected and did right back then may not work now. But I have walked into your clinic, haven’t I?,” she asked Dr Anjali Malpani, top infertility specialist and emeritus professor of gynaecology and obstetrics at KEM Hospital, Mumbai.“She embodies the story of the women who never give up despite a series of failed cycles and demonstrates how emotional guidance and counselling are an equal component for conception. I have seen women conceive easily with the right frame of mind even without changing physical parameters or processes. I have seen women take breaks and budget for them,” says Dr Malpani, who will be working with a frozen embryo for the businesswoman. “Freezing eggs and embryos means that she doesn’t have to do a pick-up (egg retrieval from a woman’s ovaries) again,” says Dr Malpani who has seen many patients coming to her after multiple cycle failures from as far as the UK, US Dubai and even from the remotest villages within India.Many celebrities — the latest being Farah Khan, who admitted to being an emotional wreck after two cycles — talk about the trauma without highlighting how they can be overcome too, feels Dr Malpani. “That creates fear and anxiety in a woman attempting such a procedure,” she says.The mentalist: A right way to hold handsDr Malpani devotes one to two hours to each patient, the major part of which is emotionally preparing them for challenges that they might face, explaining the science and preparing them to keep realistic expectations. Not everybody conceives in the first cycle, there’s half a chance if you are under 35. “Very few are lucky. There’s a 35 per cent chance of conception in the first cycle but the cumulative success rate goes up to 80 per cent after four cycles. Numbers and success rates of IVF procedures that are floating around online do not mean anything as each woman’s womb is different and the goal should be to believe that she can carry a baby. That specific focus alone helps the mother tide over cycles. That and a positive mindset. I often tell women to take a break, go on a mini vacation with their partner, have their paani puri and then come to meet me, not as a patient but as their counsellor. A relaxed mind means a better chance at conception,” says Dr Malpani.She has seen women deal with raw emotions after a cycle fails, from sadness, depression, anger at themselves, partner and families, to guilt and then acceptance. “Medically, you need to change protocol, readjust parameters, injections, review lab reports, do interventions in each cycle to ensure conception and may even need donor eggs and sperm. But do not mention the word fail for an unsuccessful cycle, instead say it is a work in progress. As doctors, we need to validate women’s journey as they budget for resources and instill the belief that they are preparing their bodies for carrying a baby to term,” she says.Dr Malpani has a support group for her patients so that they can share their challenges. As for the businesswoman who came to her after 15 failed cycles, Dr Malpani remembers having a tiff with her the first day. “She was sulking, saying she knew nothing would happen. I refused to do sonography and told her I would not do so till she had a natural smile on her face. She took some time off, allowed herself to work out her anguish, worked on her body, came back calmer and with a smile. She got pregnant in that cycle,” says Dr Malpani. Women, she insists, should take a break of one or two months before going for the next cycle.Since hormone injections that are needed before egg retrieval can trigger mood swings in women, she adopts a light-hearted approach. “Stay away from the husband and your in-laws if you feel like tearing your hair,” I tell them.Story continues below this adDr Sarah Zaidi, senior infertility specialist at Indira IVF at Dadar, Mumbai, remembers a couple who went into a downward spiral after two negative results. “They asked me why they were the only ones failing. I told them to see it as a step closer instead. The woman conceived in three months and all she did was tell herself every day that no matter what the hurdles, she would make it the third time,” she says.Partner support is equally important, adds Dr Zaidi, who has seen a woman go for the 12th cycle with the help of her partner, who was meticulous about her every protocol and did not miss a session. “That encourages the woman to keep going,” she says, having also seen many women go it alone, their husbands coming in to just give their semen samples.Why do IVF cycles fail?Failure happens because of poor egg quality, sperm-related issues, faulty embryo development, implantation failure, hormonal imbalances, uterine abnormalities and underlying health conditions such as endometriosis or polycystic ovary syndrome (PCOS).Dr Zaidi sees a lot of cases of recurrent implantation failure (RIF), when a woman fails to achieve a successful pregnancy after undergoing three or more in-vitro fertilisation (IVF) cycles with good-quality embryos. “I saw this IT professional couple from BKC who had come to me after 10 failed cycles. The woman was 44, her husband was 45. After reviewing her case, we found that some untreated infection had led to a fluid blockage in her fallopian tubes, what we call hydrosalpinx. We removed it surgically and she could conceive,” she says.Story continues below this adDr Zaidi even uses plant analogy for her patients. “The seed is the eggs, the soil is the uterus and the environmental system is the body’s immune system, fibroids, antibodies, all of which can reject the baby. This is how I explain to my patients. Sometimes embryos contain genetic error and nature deselects them,” she says.A pre-implantation genetic testing (PGT) selects chromosomally normal embryos. “That’s the way we found why a woman who had a healthy number of eggs could not conceive after six cycles. Ninety per cent of them had genetic errors. Sometimes a patient needs immunotherapy to manage immune system factors that may be blocking implantation,” she says.Prepare for financesWhile Dr Malpani has discounted packages for those who may not have enough resources, she also has a graded payment plan at her clinic.Although traditional insurance plans do not cover IVF, some health insurers are factoring in fertility treatments. “Many are offering IVF insurance coverage through specialised IVF health insurance schemes, add-ons on maternity plans. Some have easier EMI facilities, zero interest loans and cashless facilities for certain cycles,” says Dr Zaidi.Story continues below this adIn the end, there is the personal touch between doctor and couple. “Your IVF clinic and doctor should provide you with a safe zone for asking silly questions. The main part of any IVF facility is the laboratory, which must be top-notch. The selection of your clinic is important. Even if your cycle fails, experts there should be able to correct and customise the next cycle procedures,” says Dr Malpani.