58 worked cases, one for every treatment — what the patient came in with, what the workup found, what was done, and what happened.
Please read this first. These are illustrative composites. Each one is written from the kind of presentation seen regularly in this practice, to explain how a decision is actually reached — none of them is the record of an identifiable patient, and no individual's details are used. Outcomes vary enormously between people, and nothing here is a prediction of what will happen in your case.
Assisted reproduction, from the first investigation through to embryo transfer, donor programmes and surrogacy.
34, Saket · trying for 4 years · two previous IVF cycles
The eggs were always there. The protocol was suppressing them. Reading two previous cycle sheets took twenty minutes and changed the entire recommendation — including whether donor eggs were needed at all.
IVF (Test Tube Baby)29, Hauz Khas · unexplained infertility · no prior workup
Tablets prescribed without scan monitoring are guesswork. Once we could see a follicle growing and time the insemination to within a few hours, the odds changed completely.
IUI (Intrauterine Insemination)31 and 36, Dwarka · two years trying · all female tests normal
Two years and a great deal of money were spent investigating the partner who did not have the problem. A semen analysis costs very little and takes two days.
ICSI33, Green Park · two IVF cycles with poor embryo development
Embryo arrest is routinely blamed on the egg. Paternal DNA takes over at the four-to-eight cell stage, which is exactly when these embryos were stopping.
IMSI & PICSI30, Vasant Kunj · first IVF cycle · tubal factor
Three of those six embryos would have looked like reasonable transfer candidates on day three. Two more days of culture identified which ones could actually have implanted, and allowed a single transfer instead of two.
Blastocyst Culture & Transfer27, Katwaria Sarai · PCOS · first IVF cycle
Cancelling a fresh transfer feels like a setback. In a high responder it is the decision that both avoids a dangerous complication and raises the chance of success.
Frozen Embryo Transfer (FET)31, Greater Kailash · single · no immediate plans for children
The only variable that genuinely matters in egg freezing is the age at freezing. Doing it at 31 rather than 37 is worth more than any laboratory technique.
Egg Freezing32, Malviya Nagar · male factor infertility · first IVF cycle
One egg collection funded three attempts. Freezing turns a single expensive cycle into several affordable ones, and the frozen transfers are easier on the body than the stimulation was.
Embryo & Sperm Freezing43, Defence Colony · four own-egg IVF cycles · no viable embryos
A fifth own-egg cycle would have been easy to sell and very unlikely to work. Saying so cost us a cycle's revenue and saved them a year.
Donor Egg IVF30 and 33, Lajpat Nagar · azoospermia · failed surgical retrieval
Genetic testing before surgical retrieval tells you whether the operation is worth doing. In this case it prevented a procedure that could not have succeeded.
Donor Sperm & Donor Embryo36, Vasant Vihar · Asherman's syndrome · enquiring about surrogacy
Surrogacy in India has narrow eligibility and a great deal of misinformation around it. Checking the criteria first, and exhausting the uterine options, avoided an arrangement that would not have been lawful.
Surrogacy Consultation35, Nehru Place · three first-trimester losses · conceives easily
Three pregnancy losses had been attributed to her. A blood test on her husband, costing very little, found the actual cause after the second loss would have been the right time to do it.
PGT-A / PGT-M (Genetic Screening)34, Munirka · azoospermia · normal hormones
Obstructive azoospermia has a sperm retrieval rate close to 100%. The hormone profile and ultrasound told us that before the procedure, which is why it was booked as a same-day case rather than a major operation.
PESA / TESA / TESE33, Rajouri Garden · low count and motility · no female factor
Sperm take about 74 days to develop, so nothing shows before three months. That delay is why correctable male factors are so often skipped in favour of going straight to ICSI.
Male Infertility Treatment28, Chittaranjan Park · 18 months trying · irregular cycles
She was one blood test away from a diagnosis and had been offered a two-lakh treatment instead. The basic workup exists precisely to find this kind of thing.
Female Infertility Treatment26, Uttam Nagar · PCOS · anovulation
A year of unmonitored clomiphene produced no information. Four monitored cycles produced a pregnancy, and we knew after each one exactly what had happened.
Ovulation Induction & Follicular Monitoring36, Saket · four failed transfers · good-quality blastocysts each time
Chronic endometritis is common after repeated implantation failure, is easily treated with an inexpensive antibiotic, and is missed constantly because nobody looks inside the uterus.
Recurrent IVF Failure32, Kalkaji · two miscarriages at 9 and 11 weeks
Investigation after two losses, not three, found a treatable condition with one of the strongest evidence bases in obstetrics. Waiting would have meant a third avoidable loss.
Recurrent Miscarriage38, Green Park · AMH 0.4 · one cancelled cycle
Very high doses do not create eggs that are not there. Three gentle cycles at lower cost produced what one maximal cycle could not, by accumulating rather than transferring each time.
Low AMH & Poor Ovarian Reserve29, Lajpat Nagar · newly diagnosed breast cancer · chemotherapy due
Random-start protocols removed the two-week wait, and a letrozole-based approach made stimulation appropriate in hormone-sensitive disease. The delay to cancer treatment was zero.
Fertility Preservation for Cancer Patients34, Panchsheel Park · three failed euploid transfers
ERA helps only the minority whose window is genuinely displaced, which is roughly a quarter of women with repeated implantation failure. Offered to everyone it is an expensive irrelevance; offered to this group it can be the whole answer.
ERA — Endometrial Receptivity Testing33, Mayur Vihar · Asherman's after curettage · four cancelled transfers
PRP has a reasonable evidence base specifically in refractory thin endometrium, and none as a general add-on. Used for the indication it was studied in, it turned four cancellations into a transfer.
PRP for Thin Endometrium & Ovarian Rejuvenation34, Vasant Vihar · hysterectomy for postpartum haemorrhage · wanting a second child
The clinical work took four months; the certification took ten. Doing the eligibility and documentation first meant the IVF cycle was not paid for and then stranded.
Gestational Surrogacy Programme29, Chittaranjan Park · periods stopped at 27 · no cause found
Two things were needed and they are easy to conflate: treatment for a medical condition she will have for twenty years, and a route to a family. Separating the two conversations gave her room to absorb the first before deciding on the second.
Egg Donor Programme41 and 46, Nehru Place · failed donor egg cycles · severe male factor
Technically this was the simplest treatment either of them had: no stimulation, no retrieval, one transfer. Emotionally it was the hardest, which is why the counselling took longer than the medicine.
Embryo Donation & AdoptionPregnancy and gynaecological scanning, performed by the treating consultant rather than sent out to an imaging centre.
26, Saket · irregular cycles · first scan at 8 weeks
A due date ten days out does not sound serious until the baby is called growth-restricted at a gestation it has not reached, or induction is advised a week and a half early.
Early Pregnancy Scan (Dating & Viability)36, Green Park · NT scan at 12+3 · first pregnancy
A raised NT is not a diagnosis, and most babies with one are normal. But it earns a fetal echo even after a normal chromosomal result, which is the step most often skipped.
NT Scan & Dual Marker Test30, Mayur Vihar · anomaly scan at 19 weeks · no risk factors
There was nothing in her history to suggest she was at risk. The only reason this was found is that the cervix was measured at a scan where it often is not.
Anomaly Scan (Level 2 / TIFFA)33, Okhla · reduced fundal height at 32 weeks
A small baby with normal Dopplers is usually just small. Delivering it early on the basis of the centile alone converts a healthy small baby into a premature one.
Growth Scan & Doppler Study28, Dwarka · suspicious facial view at the anomaly scan
3D was used here for what it is actually good at — defining a surface anomaly seen on 2D — rather than as a keepsake. Knowing before birth let the family meet the surgical team and arrange feeding support in advance.
3D & 4D Ultrasound35, Lajpat Nagar · type 1 diabetes · HbA1c 8.4% at booking
Transposition is invariably fatal without prompt intervention, and a baby born with it at a hospital that does not know collapses at home in the first week. A normal four-chamber view does not exclude it.
Fetal Echocardiography31, R.K. Puram · first IVF cycle · high antral follicle count
That dose change happened within an hour of the scan. Where scanning is outsourced to an imaging centre and reported the next day, the same cycle frequently ends in an admission.
Gynaecological & Follicular UltrasoundConditions affecting the reproductive organs — diagnosed properly, and treated with the least intervention that works.
24, Janakpuri · PCOS · acne, weight gain, irregular periods
PCOS treated only as a period problem stores up a metabolic one. She was not trying to conceive, which made this the right time to deal with the underlying cause rather than suppress the symptom.
PCOS / PCOD Treatment27, R.K. Puram · severe dysmenorrhoea since 16 · infertility 2 years
Excision recurs far less than ablation, and measuring reserve before operating on an endometrioma is what keeps the surgery from costing her the fertility it was meant to protect.
Endometriosis Treatment35, Karol Bagh · two failed IVF transfers · multiple fibroids
Position decides whether a fibroid matters, not size. A 2 cm fibroid in the cavity halves implantation; an 8 cm one on the outer wall often changes nothing.
Fibroid Treatment & Myomectomy23, Munirka · 6 cm ovarian cyst · surgery advised elsewhere
Functional cysts come and go with the cycle. Removing one costs a young woman ovarian tissue she will need, and an eight-week wait answers the question at no cost at all.
Ovarian Cyst Treatment30, Vasant Kunj · unexplained infertility · three failed IUIs
An HSG tests whether dye passes through. It cannot tell you whether the tube can actually collect an egg. In unexplained infertility with a surgical history, that distinction is worth a laparoscopy.
Diagnostic & Operative Laparoscopy37, South Extension · two failed IVF cycles · intermenstrual spotting
Ultrasound misses a meaningful proportion of small cavity lesions. Before a repeat IVF cycle, looking directly is cheaper than another failed transfer.
Hysteroscopy31, Dwarka · bilateral hydrosalpinx · planning IVF
Transferring an embryo into a uterus being washed by hydrosalpinx fluid roughly halves the success rate. Two months' delay and one operation restored the odds to normal.
Tubal Blockage & Hydrosalpinx29, Uttam Nagar · secondary amenorrhoea · thin endometrium
Genital TB is diagnosed on tissue, never on a blood test — her serology was negative while her biopsy was positive. It is one of the most under-diagnosed causes of infertility in India.
Genital Tuberculosis in Infertility41, Paschim Vihar · heavy periods for two years · exhausted
She had been treated for the consequence twice without anyone looking for the cause. One scan and one day-case procedure resolved a problem she had lived with for two years.
Irregular & Heavy Periods46, Greater Kailash · perimenopause · sleep and mood
For a healthy woman starting within ten years of menopause, the benefits of hormone therapy generally outweigh the risks. 'It is natural' is not a treatment plan.
Menopause & Perimenopause Care34, Mayur Vihar · recurrent discharge and itching for a year
One swab after the first recurrence would have saved a year of treatment aimed at the wrong organism — and found a metabolic problem nobody was looking for.
Vaginal Infections & Discharge38, Saket · heavy periods · family complete
She came asking for sterilisation for one problem and had another she had accepted as normal. One device treated both, reversibly, without an operation.
Contraception & Family Planning34, Alaknanda · routine screening · no symptoms
This is what screening is for. Left alone, CIN 3 progresses to invasive cancer in a substantial minority of women over a decade or so. Found at this stage it is a fifteen-minute outpatient procedure.
Pap Smear, HPV Testing & Vaccination16, Malviya Nagar · primary amenorrhoea · brought by her mother
A sixteen-year-old receiving a diagnosis like this needs it explained to her, not over her head to her parents. The medicine took one appointment; the conversation took three.
Adolescent Gynaecology42, Chirag Delhi · heavy bleeding · hysterectomy advised
Hysterectomy is the right answer for some women. It should not be the first answer when no medical option has been tried, and offering it first is why many women stop coming.
Laparoscopic Hysterectomy36, Okhla · advised laparotomy for an 'ovarian mass'
A mildly raised CA-125 with an endometrioma is expected and frightens people unnecessarily. Twenty minutes of history-taking and a careful scan changed an open operation into a day-case laparoscopy.
General Gynaecology ConsultationPregnancy, delivery and the months either side, looked after by the same consultant throughout.
31, Vasant Kunj · first pregnancy · family history of diabetes
Undetected gestational diabetes produces large babies, shoulder dystocia and neonatal hypoglycaemia. She had no symptoms at all — the only reason it was found is that the test is done routinely.
Antenatal & Pregnancy Care34, Defence Colony · chronic hypertension · previous pre-eclampsia
Aspirin works only if it is started before 16 weeks, which means the risk assessment has to happen in the first trimester. Waiting for symptoms is too late.
High-Risk Pregnancy Management29, New Friends Colony · second pregnancy · previous caesarean
The difference between a planned accreta delivery and an unplanned one is measured in litres of blood. A 19-week scan bought seventeen weeks of preparation.
Pregnancy Ultrasound & Scans30, Kalkaji · one previous caesarean · wanting vaginal birth
VBAC is reasonable in carefully selected women and succeeds around two-thirds to three-quarters of the time. It needs a doctor willing to be patient, which is the part that is actually in short supply.
Normal Delivery33, Greater Kailash · first pregnancy · breech at term
Breech at term is a genuine indication. Offering version first, then documenting why the caesarean is needed, is the difference between a caesarean and an unnecessary one.
Caesarean Delivery32, Dwarka · twins after IVF · referred at 12 weeks
Chorionicity is easy to determine before 14 weeks and almost impossible afterwards. It is the single most important piece of information in a twin pregnancy, and it decides the entire monitoring plan.
Twin & Multiple Pregnancy Care37, Hauz Khas · IVF pregnancy after 3 failed cycles and 2 losses
The medicine in an IVF pregnancy is mostly ordinary obstetrics. What is not ordinary is the fear, and building extra scans into the plan for that reason alone is legitimate care.
Pregnancy Care After IVF28, Rohini · epilepsy · planning pregnancy
The neural tube closes by 28 days, often before a woman knows she is pregnant. A medication switch that takes three months has to happen before conception, not after the positive test.
Preconception Counselling29, Janakpuri · first baby · routine postnatal visit
She said she was fine, because that is what people say. Screening for postnatal depression means asking directly, and it takes two minutes.
Postnatal Care27, Katwaria Sarai · cracked nipples · considering stopping
Most breastfeeding failure is mechanical and fixable, and the window where help matters most is the first fortnight. One properly observed feed found what three weeks of advice over the phone had not.
Lactation & Nutrition CounsellingIt is your own, and it starts with an hour going through your reports. Bring everything you have.