World IVF Day – a day for hope and positivity

World IVF Day is a day to celebrate science and be hopeful.

On this World IVF Day, my message to everyone, especially to those undergoing treatment for infertility, is to stay hopeful. Scientific advancements have significantly simplified the process and improved the treatment outcome, since the first successful IVF procedure back in 1978, which resulted in the birth of Louise Brown in the UK.

If you are struggling to conceive, my suggestion is to consult an infertility specialist now and start treatment early.

Five questions to ask while choosing an Infertility Clinic

We are living in an age of consumerism, and healthcare has also been affected by it. In India, several Infertility clinics and IVF centers have come up over last few years. While this has helped fill in the demand supply gap in this field bringing in much needed competition and has given more options to the patients, this has also prompted aggressive marketing by these clinics is in order to attract more patients, thereby confusing patients on how to go about choosing their doctor and treatment center. Healthcare is a very sensitive subject and we have to be able to filter the right information from all the noise in order to be able to make the best decisions for ourselves.

In my own clinical experience, I have had several couples who have consulted me for their inability to have a child, and who were confused due to information overload on the subject and vastly varying offers and claims from infertility clinics. Patients often ask me how should a patient decide which infertility clinic is best for them and what parameters should they consider when selecting an Infertility clinic for treatment. I suggest my patients to ask these five questions before selecting an infertility specialist doctor and an IVF clinic for treatment.

Question 1 – What is the real cost of IVF treatment at the center?

Nowadays there is a flurry of ads on radio, newspapers and digital platforms, several of which try to attract patients by advertising the lower cost of IVF – at times claiming to do an IVF cycle for as low as Rs 25,000 only, while at others offering one IVF cycle free with one paid cycle. The lower cost of treatment is always better for the patients. However, it is important that patients also understand the “conditions apply” clause and read in between the lines to understand the overall cost implication before making their choice on the basis of low cost alone, so that they are not taken for a ride!

It’s important to understand that a typical IVF cycle includes several steps, namely  investigations of the couple, hormone injections for 10-11 days in order to stimulate maturation of eggs, the procedure of egg retrieval and finally transfer of embryo into the lady’s uterus. Patients should understand and take into consideration the overall cost of treatment, as at times the advertised cost may not include cost of hormones and investigations which contribute significantly to the overall cost of a cycle.

Question 2 – What is the success rate of IVF at the clinic?

Another very important parameter to check is the success rate of the clinic and also understand how the claimed success rate was calculated. While the success rate for IVF do vary from one center to another, and the patients should certainly go for treatment at centers with superior pregnancy rate, it’s important to do an apple to apple comparison of success rates.

The pregnancy rates are generally much higher in younger women undergoing IVF. Similarly, success rate for IVF is much higher among infertile couples using donor eggs as compared to the ones using their own gametes. Therefore, the claimed success rates at clinics doing a lot of donor egg cycles can actually be higher than centers with a more balanced distribution of cases.

My simple advice on this point is – if a clinic offers donor egg option without any justification or declares the patient to be having poor quality of eggs based on an ultrasound report and without doing an IVF cycle, the patient should get alert and seek a second opinion before making a decision. As such there is no way to assess the egg quality based on ultrasound or blood reports, which, at best, can estimate the ovarian reserve. There is no way to evaluate the egg quality other than to take the eggs out and check them for quality in the lab.

Question 3 – What is the incidence of multiple pregnancies with IVF at the center?

The aim of any infertility treatment is to enable a couple have a healthy child. So, one should always ask what is the protocol for the maximum number of embryos transferred in a cycle at the clinic.

There is a tendency to transfer more than one embryos in a cycle, which is based on the assumption that the chances of pregnancy in a cycle increases by transferring multiple embryos. However, the best outcome of a cycle can be achieved by transferring 1 or maximum 2 properly selected embryos. Not only does multiple embryo transfer not increase the chances of pregnancy, it, in fact, increases the risk of multiple pregnancies, thereby increasing the risk to both mother and child. Multiple pregnancy is the biggest complication of IVF treatment and the risk of multiple pregnancy is directly proportional to the number of embryos transferred in a cycle.

Question 4 – How good is the IVF lab at the center?

This is an often ignored aspect while choosing an IVF center over the other. But, a well-equipped and maintained lab is a crucial factor differentiating a good IVF center from a not-so-good center. Patients should understand that a well-equipped lab with strong quality control and quality assurance program will always do more justice to their eggs, sperms and embryos and maximize their chances of pregnancy. A good IVF clinic needs to have a good embryo freezing program in order to properly manage the extra high quality embryos from an IVF cycle for possible use for the same patient in future. This helps in preserving the precious embryos and also reduces the cost of possible IVF interventions in future. Many centers claiming a low cost IVF often don’t have a good embryo freezing options for the patients.

Likewise, a properly trained and experienced embryologist also plays an important role in success of the IVF program. So, patients should inquire about the background and competence of the embryologist also while they do the background check on the treating clinician.

Question  5 – Does the center have patient support program?

This is another lesser investigated aspect while choosing an infertility clinic for one’s treatment.  In my view, availability of a good support team including fertility counselors is as important a factor as having a good infertility specialist doctor in improving the success of IVF treatment. Good counselors help the patients understand their issues holistically and helps them overcome the stress associated with infertility. This, combined with the skills and personalized attention of the treating doctor, plays an important role in improving the outcome of IVF treatment.

So, next time you see an enticing, “too good to be true” offer for IVF treatment at an infertility clinic, stop and ask yourself these five questions before falling for it. Always remember, choosing the right infertility expert and the right infertility clinic for your treatment will largely decide the outcome of your treatment!

Do write to me at if you have any questions about IVF.

IVF – A blessing or a bane?

Many patients who have been advised IVF treatment wonder if they will have a normal baby at the end of it and if the IVF carries higher risk of certain disorders. Education from credible and scientific sources helps bust several myths on this subject.

As an IVF specialist I often come across questions from my patients about safety of IVF procedure and the well being of the offspring resulting from IVF. Many patients ask me if the IVF baby could, in any way, be different from a normally conceived baby, and are, at times, reluctant to undergo the fertility treatment. Many of these patients quote some horror stories of other patients who have undergone IVF.

What I explain to the patients is that most of the times they get to hear just one side of the story. I try to make them understand that IVF is a medical procedure used to help couples conceive who find it difficult to conceive for several biological reasons. Just like all other medical interventions, IVF also has its own set of disadvantages, and can, at times, cause inconvenience to women undergoing treatment.

If you have been recommended to undergo IVF as the best way to conceive, I suggest you  not to form any preconceived opinions about the procedure based just on hearsay. Instead, you should discuss the pros and cons of the procedure, possibility of its success and chances of any inconvenience etc with your treating specialist and to educate yourself about the science behind the procedure from authentic sources. As Benjamin Franklin once said – “An investment in knowledge pays the best interest”!

I will continue to write on this subject to answer some frequently asked questions and address the common myths about fertility treatment, specially using IVF. Do write to me at if you have any questions about IVF.

Looking beyond Semen Analysis as a marker for Male Fertility

Its often difficult to pin down the real cause of male infertility as the assessment of the male partner remains restricted to semen analysis and a normal report is used to rule male factors out. Many of these incompletely evaluated men and couples can benefit from further investigation of the male partner, which not only helps start proper intervention for conception early on, but also saves lot of mental stress and stigma for the woman partner.

It’s a well-known fact that male factor contributes to a couple’s inability to conceive in up to 40% of all cases of infertility. In practice, however, the inability of a couple to conceive is still seen largely as a woman’s problem. In fact, one of the most common initial responses of the male partners that we come across when assessing them is that all “I am healthy and all my reports are good” and then the whole responsibility is shifted to the woman partner alone.

So, what does “my reports are all good” actually mean? This refers to normal semen parameters as noted on standard semen analysis. But then the real question is if a normal semen analysis report indeed rules out male factor infertility! Recently there has been a big debate on how good a good semen analysis report actually is and if it is an accurate indicator or predictor of a man’s fertility. Well, the simple answer is No, it is not!  And, even though semen analysis offers a good initial assessment of male partner, there is more to sperm health and function than what a standard semen analysis picks up. It is now 300 years since Leeuwenhook first identified sperms under the microscope, yet it seems that we have only just begun to intelligently evaluate the concept of male Infertility and till date semen analysis remains the cornerstone for evaluation of male fertility.

Sperm production in the testis is a lengthy and tedious process and any adverse influence during the sperm production or maturation process can lead to an adverse sperm health and/or quality. According to estimates, up to 10% of men having normal semen parameters can actually fail to conceive due to undetectable damage in the spermatozoa. These men can be infertile without actually being aware of it and are often classified as unexplained Infertility, unless they are further investigated properly. Therefore, it is very important that the evaluation of male partner is not limited to only semen analysis, and is combined with comprehensive history taking, clinical examination and relevant endocrine /genetic investigations.

The real shortcomings of semen analysis include its inability to predict the fertilization potential of the sperms and the overall functional health (DNA integrity) of the sperms. Thus there is an increasing awareness about the need of supplementary tests to evaluate male partner and look beyond only semen analysis to assess the male factor infertility.

The reasons for infertility in such men can be attributed to development of anti-sperm antibodies, which interfere with a sperm’s ability to fertilize the egg. These antibodies cannot be detected on routine semen analysis and we need specialized tests to detect them. Also, the tests to detect anti-sperm antibodies have been in existence for a long time but since there is no particular treatment for this condition, these tests have not gained a lot of acceptance in clinical evaluation of infertile men. However, since these men benefit from IVF or ICSI for conception, an early detection of anti-sperm antibodies helps in overall management of the couple.

Another very common, and often missed, cause of male factor infertility is damaged sperm DNA. As discussed in one of my earlier articles, DNA is the basic genetic material and any abnormality or alteration in the sperm DNA affects its fertility potential – not just for natural conception, but also for IUI and IVF treatment. Damage to sperm DNA can happen at any stage of its development, maturation or transport – starting from beginning of spermatogenesis till the time of ejaculation. A number of factors can cause high DNA fragmentation. These include lifestyle factors such as smoking, excessive drinking and drug abuse, advanced age, exposure to environmental toxins, varicocele and infections causing oxidative damage to DNA.

One more factor leading to male factor infertility is dysfunctional sperms, as a result of which the sperms  may not be able to fertilize the eggs naturally. All these causes of infertility may be present in men with normal semen parameters.

ICSI has helped numerous couples with male factor infertility with seemingly normal semen parameters conceive by injecting the sperm directly into the egg for fertilization. This technique helps bypass many of the shortcomings of the sperms, but also increases the risk of selecting defected sperms, which could then pass  onto the offspring.

There is a lot of research in the field of andrology to understand and improve the health of sperms. This can help in not just improving the diagnosis of infertility and reducing the burden of unexplained Infertility, but also devising directed therapies to improve outcome of fertility treatments.

I will write about what should be done for couples having unexplained infertility with the male partner having normal semen parameters on semen analysis.

For any questions, please write to me at

Birth control pills and Infertility

One of the most common myths around infertility is whether past usage of birth control pills by a woman can result in infertility later on. If you also have a similar query, please read on for an answer!

Many women with suspected/ diagnosed infertility often ask me if their infertility could have resulted from usage of birth control pills in the past. There is clearly no such association between using birth control pills and infertility and suppression of fertility by birth control pills gets completely reversed on discontinuing the pill. Let us first understand how the birth control pills actually work, and, then we will discuss why these pills cannot lead to infertility.

History of birth control pill

Birth control pills have been in existence since year 1957, when the US FDA approved using these hormonal tablets for treatment of severe menstrual disorders. However, they became much more popular some three year later, when the same US FDA approved using these pills as “birth control pills”. Over these 55 years, this magical medicine has been safely used by millions of women all over the world to control when they want to be mothers, and therefore, have been touted as a “woman’s best friend”.

The pills have evolved over all these years and the new generation birth control pills, which are uses these days contain much lesser quantity of hormones than their original predecessors. This makes the modern pills much safer for women, while being equally efficacious in preventing ovulation and controlling the menstrual cycle.

How do birth control pills work?

Birth control pills are essentially hormone pills containing female sex hormones – estrogen and progesterone. These hormones send negative signals to the pituitary gland located within the brain, thus stopping production of follicle stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. FSH and LH are responsible for maturation of a growing follicle and ovulation during the normal menstrual cycle. Circulating FSH and LH do not allow the uterine lining to grow appropriately. This, in turn, leads to formation of abnormal cervical mucus, which inhibits swift movement of sperms and also doesn’t allow the embryo (if it forms) to settle in the endometrium.

Can use of birth control pills lead to infertility?  

The simple answer is “No”, because the pill just contains the synthetic version of the hormones which are otherwise also produced inside the woman’s body!

There is now enough scientific evidence to refute any cause- effect relationship between intake of birth control pills and subsequent infertility. Some temporary disruption in menstrual cycle for a few months after stopping the pill is known to occur in some women and is known as “post-pill amenorrhea”. But even this phenomenon is mostly unrelated to intake of pill per se and is rather caused by coexisting problems such as being underweight or depressed. Most of the women resume their normal “pre-pill” cycles within 1-3 month of stopping the pill and are ovulating normally by this time.

What are the benefits of using birth control pills for subfertile women?

Birth control pills provide some additional benefits to enhance fertility among women.

  1. In women with irregular cycles, especially due to polycystic ovaries (PCOS), birth control pills are used to improve hormonal imbalance as a premedication before starting fertility treatment. Read here for more information on PCOS and infertility.
  2. Birth control pills are very useful in managing the excessive facial hair growth (hirsutism) in patients with PCOS. The pills suppress the level of circulating male hormones in the body of these patients, which is the major cause of facial hair growth. Read more about hirsutism and role of birth control pills in its treatment here.
  3. Birth control pills also provide some protection against Pelvic Inflammatory Disease (PID) – an infective condition of the female reproductive organs leading to inflammation and blockage of tubes. The pills cause thickening of cervical mucus, which protects the reproductive organs from infections by preventing transport of infective organisms into uterus and tubes. You can read more about PID and infertility in my upcoming post.
  4. Birth control pills help in improving the symptoms of endometriosis, especially the pain associated with it. Using the pills also slows down the progression of the disease by reducing the level of circulating estrogen in body. I will be writing on this subject soon.
  5. Intake of birth control pills is also known to reduce the risk of cancers of ovaries and uterus, which themselves could affect the woman’s fertility.

Are there any risks associated with use of birth control pills?

Birth control pills falls under the category of “Schedule H” drugs in India, which means that a physician’s prescription is required to purchase these pills. Irrespective of this regulations and like for any other medication, birth control pills should always be started only on a doctor’s advice. Although the modern pills are very safe and have minimal side effects/ complications in vast majority of users, there are situations in which the pills should be used with caution/ not used at all, such as women over 40 years of age, smokers, women with known liver diseases or clotting disorders etc. Please read more about such contraindications in the suggested readings below and consult your gynecologist before starting the pill.

Further readings


Making IVF Patient Friendly with Milder Stimulation

It is time to adopt more physiological and patient friendly ovarian stimulation strategies for IVF, which require lesser amount of hormonal stimulation and still produce 2-3 follicles for IVF. Such minimal/ mild stimulation protocols should preferably be used in the modern infertility practice.

There has been good debate on what is the correct number of eggs to be retrieved and number of embryos to be transferred during an IVF cycle. The debate revolves around success rate and cost of the procedure and patient comfort and compliance. I will try to address the first of these two questions, i.e. whats is a good number of eggs to retrieve during an IVF cycle and how should one go about it.

Technically speaking, a single egg has the potential for fertilization and the first IVF baby was born from a natural cycle IVF. But, not every egg gets fertilized on being exposed to sperms and not all embryos have the potential to result in a pregnancy. This inherent failure of assurance of pregnancy resulting from the transfer of a single embryo (fertilized egg) after IVF has resulted in evolution of the practices of artificially inducing the ovaries to produce many eggs in a cycle and of transferring more than one embryo into the uterus. However, even these interventions do not guarantee success of the IVF cycle and the outcome of such IVF cycles can also be measured only in terms of probability.

What is the standard IVF practice?

The standard practice is to give daily hormonal injections to induce the growth of many eggs (targeted number of eggs varies from 5-6 to up to 10), which is coupled with strict monitoring using ultrasounds and blood tests. This process is often very stressful and unfriendly for the patient. This also entails a risk of some complications due to the stimulation which can be short term and may have some long term sequel as well.

What are the disadvantages of conventional stimulation protocols for IVF?

The conventional stimulation protocols have following disadvantages-

  1. Patient discomfort associated with daily injections
  2. Risk of complications like ovarian hyperstimulation, which occurs as a result of recruitment of excessive number of follicles.
  3. In patients with poor ovarian reserve, higher dosage of hormones may not yield more eggs because stimulation helps in recruitment of follicles already present in the ovaries.
  4. Quantity does not correlate with quality – Retrieval of a larger no of eggs may not necessarily mean better quality of eggs. In fact, many of these eggs may be of poor quality and some may even have aneuploidy.
  5. Excessive production of hormone Estradiol (produced by a larger no of growing follicles) has a negative impact on the endometrial receptivity, i.e. the ability of endometrium to allow implantation of the embryos. This may negatively affect the outcome of the cycle.


Standard ovarian stimulation – Growth of multiple follicles

What is minimal/ mild stimulation IVF?

Minimal/ mild stimulation strategy aims to optimally stimulate the ovaries to produce a few (typically 2-7) follicles, rather than bombarding them with hormones in order to produce a larger numbers of follicles. This strategy yields a smaller no of follicles, but these follicles are optimally primed to grow and are likely to be healthier. These protocols use either only oral medications or a combination of oral medications and lower dose of hormones given for a shorter duration. Mild stimulation strategies are specially beneficial for IVF in women, who are at higher risk of hyper-stimulation or are known poor responders.

What are the advantages of minimal/ mild stimulation IVF?

Minimal/ mild stimulation IVF, sometimes also called as micro IVF or mini IVF offers several advantages to select group of patients. These include-

  1. The minimal/ mild stimulation protocols are more patient friendly as they require relatively lesser medical intervention.
  2. Minimal/ mild stimulation is more physiological and in sync with woman’s natural cycle.
  3. Growth of lesser number of follicles means a less steep rise in the levels of hormone Estradiol, as a result of which endometrium is likely to be more receptive, thus achieving good pregnancy rate despite of lesser number of eggs.

three follicles
Minimal ovarian stimulation – growth of three follicles

This is the time to reconsider ovarian stimulation strategies for IVF, so that a good pregnancy rate can be balanced with more physiological and patient friendly treatment.

Further Readings



Living with PCOS- Survival Kit!

The affected woman has to take the ownership of her treatment in order to beat PCOS.

How to tackle PCOS?
How to tackle PCOS?

         If you are one of those 30% of women having PCOS, then this is your space! 

PCOS is a very common, yet often misdiagnosed condition and many women will call themselves as polycystic ovarian disease (PCOD) or polycystic ovarian syndrome (PCOS) without knowing its full meaning and implications.

What is PCOS?

It is important to understand that PCOS is not a disease, but a syndrome- which literally means that it is a group of symptoms resulting from involvement of multiple systems of body. It can affect anyone from a young adolescent girl to an adult woman even beyond a woman’s reproductive age. The name polycystic ovary is derived from the typical appearance of the ovaries, wherein multiple small cyst like spaces can be seen inside the ovaries. But, one must understand that this polycystic appearance of the ovaries is an outcome of the syndrome rather than being a cause for that. The PCOS can present in many ways, which can range from common symptoms such as weight gain, acne, facial and excessive body hair (hirsutism) and irregular menstruation to very serious medico-social issues such as infertility, diabetes, hypertension and uterine cancers.

Polycystic ovaries
Polycystic ovaries

So, how does one suspect if she is having PCOS?

PCOS can manifest for the first time right at puberty. The affected girls may gain a lot of weight all of a sudden and may continue to struggle controlling weight for many years. Weight gain could be accompanied by menstrual irregularities, facial hair and acne, besides many other similar symptoms. While diagnosing PCOS at this stage can be really tricky because there is no single test that’s diagnostic of this condition, most of the symptoms described above can actually be controlled with help of oral contraceptive pills. However, when these women on birth control pills start planning a baby and have to stop taking the pills, many of them discover that they are unable to conceive. Consultation with an expert is very helpful at this stage, as the expert can correctly diagnose the problem and also advise on the best way to manage the symptoms. But, the affected woman has to take the ownership of her treatment in order to beat PCOS. This would include maintaining an active lifestyle with regular exercise and having a low carbohydrate diet in an effort to keep the weight under check. These interventions go a long way in controlling the symptoms of PCOS, as weight gain initiates a vicious cycle of further hormonal imbalance, which in turn leads to more weight gain. Lifestyle correction coupled with appropriate use of medications to reduce the insulin resistance is the best way to manage PCOS.

What if one gets diagnosed with PCOS? Is it over for her now?

Most common question that I get asked is if PCOS can be cured? Very sadly the answer is No- PCOS cannot be cured! But, the symptoms of PCOS can most certainly be controlled using appropriate medical treatment and lifestyle interventions described above. The key to control of these symptoms is diagnosis at an early age and well titrated intervention from an expert. Remember that it is a condition of hormonal imbalance in the body, which results in irregular ovulation, over production of male sex hormones and resistance to the action of insulin. So, in very simple words, all the interventions would be focused on correcting this hormonal imbalance in the body.

So, what can be done to manage infertility in PCOS patients?

Most women with PCOS are able to overcome the challenge to their fertility with proper treatment. This treatment may vary from simple measures such as oral tablets to induce ovulation to IUI and all the way to IVF. One should always seek an expert’s opinion for management of PCOS when planning for a baby, as the doctor is the best person to support in this endeavor. Always remember that PCOS stays with the woman throughout her journey of life and she has to remain vigilant to identify its long term risks such as diabetes, hypertension and uterine cancers in their early stage!

Reading resources

You can use the following resources to understand more about PCOS, its implications and treatment options-




Alternatively, you can write to us at with your queries.

Mind your weight so you don’t have to wait!

Mind your weight so you don’t have to wait!

An anxious, overweight woman came in to consult me a couple of weeks back. She has been trying to conceive for two years but has been unsuccessful. Now she has not had her menses for last 9 weeks but her pregnancy test was negative. She has been having her periods irregularly for last many years.

A rapidly growing and often ignored problem

The number of young overweight women and men seeking medical assistance for planning family is on a rise. Being overweight not only affects ones’ chances of becoming a parent, but also can lead to complications in pregnancy- adversely affecting both mother and baby.  Therefore, it is very important for all young men and women to know the fundamentals of causation and detection of this important disorder.

Mind your weight so you don’t have to wait!

When to be concerned?

The most often asked questions in this context are- what is a normal acceptable weight, when does one get labelled as overweight and what is the definition of obesity? Another important question we often get asked is- what’s the difference between being overweight and obese? In very simple terms, what a physician evaluates to check for obesity in a person is a simple index known as “body mass Indexor BMI. BMI can be calculated by simply dividing the person’s body weight in Kg by the square of person’s height measured in meters.

BMI is measured as Kg/m2

In very simple terms, a BMI of 18-24 is considered to be normal and anyone having a BMI beyond this range is either overweight or obese. Many simple calculators to measure one’s BMI are freely available on internet. You can try one of the following links to check your BMI-

The following are broad guidelines for detection of obesity-

  • BMI of < 18.5 indicates that the person is underweight
  • BMI between 18.5 and 24.9 indicates that the person has got normal weight
  • BMI between 25 and 29.9 indicates that the person is overweight
  • BMI of > 30 indicates obesity

How does Obesity affect fertility?

Excessive body weight in women causes multiple hormonal imbalances, which can result in irregular menstruation and reduced frequency of ovulation, thus leading to infertility. Also, the outcome of Infertility treatment in obese women is poorer than in their normal weight counterparts. Obesity also increases the chances of pregnancy related complications such as miscarriage, pregnancy induced hypertension and gestational diabetes and hence increases the requirement offers cesarean delivery. And not to forget that the labor is that much harder and prolonged for obese women.

Obese males also suffer from reduced fertility as they tend to have lower level of testosterone, which suppresses sperm production. Obesity can also case erectile dysfunction in men, which can result in reduced fertility.

What can you do?

So, what to do if you are struggling getting a baby and have been diagnosed as overweight or obese? Here are five easy weight management tips to help you realize your dream of having a child-

  • Watch your meals- take a healthy diet and avoid excess carbohydrates and fat
  • Watch your beverages- drink adequate quantity of water, avoid soft drinks as they contain empty calories and refrain from alcohol
  • Stop smoking and keep in mind that there is nothing like occasional/ moderate smoking
  • Exercise regularly and maintain a healthy, active lifestyle- short sessions of brisk walking, swimming, jogging or skipping are good means to keep one active and healthy
  • Avoid stress and practice Yoga/ meditation or other stress buster techniques that suit you

Want to know more or seek an expert opinion, write to us at today!