Monday, March 01, 2010

Why doctors avoid patients when the IVF cycle fails !


I see lots of patients who have failed IVF cycles in other clinics. It often depresses me when I see how little patients understand about why their IVF cycle failed. Patients are understandably frustrated when the cycle fails and this is aggravated when they do not get a clear answer from their doctor as to why the cycle failed. They feel forsaken and believe the doctor has abandoned them after extracting a huge amount of money. Others may suspect that the failure was because the doctor did something "wrong" - and when the doctor does not provide answers, this suspicion gets reinforced ! While everyone knows that the IVF success rate is not 100%, patients need to learn from each cycle, so they can optimise their chances of success in their next cycle.

Unfortunately, many doctors will avoid patients when the cycle fails. They'd rather not answer difficult questions. Many refuse to meet the patient when the cycle fails because they don't like giving bad news. Others will talk about "fate" or " luck", so the patient remains in the dark. Often, the only suggestion is - Let's repeat the cycle again. Other doctors will fob off patients by providing meaningless reasons for the IVF failure, such as - Your eggs are weak; or your uterus is hostile. The worst are the doctors who will run additional tests ( for example, for checking sperm DNA fragmentation; or immunological tests for NK cells) , and then trot out abnormalities in these as being "scientific explanations" for why the embryos did not implant !

A good doctor will provide a honest answer as to how limited our understanding of embryo implantation is; and then provide the rationale for what advise he gives to the patient regarding their future course of action. Sadly, this is often missing. Patients are rarely given even a basic treatment summary , forget about details such as the embryo quality and morphology.

Even worse, many doctors will " blame " the patient for the IVF failure ! Some will claim that the cycle failed because the patient did not take bed-rest; or was too "stressed out". Others will blame the egg quality and suggest alternative options such as donor eggs or surrogacy, at the drop of a hat !

While the final outcome of an IVF cycle is not in either the doctor's hands or the patient's, a good clinic will provide high quality medical documentation of the treatment cycle and will take the time to educate and counsel patients as to what happened, so they can then decide what to do next. This is a decision the patient needs to make, but it should be a well-informed decision !



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