Tuesday, August 03, 2010
Why is the care provided in most IVF clinics so poor ?
Most patients will vouch for the fact that the care provided in many IVF clinics leaves a lot to be desired. The clinic does not seem to have a treatment plan or protocol - and even if it does, this is not shared with the patient, who is often clueless about what is going to happen next ! There is very little communication amongst the staff, and often it seems that the right hand does not know what the left hand is doing. It seems that all the treatment is done on a daily, ad-hoc basis, and this lack of transparency create a lot of unease and distress. Also, because the senior" doctor is never available , it seems that all the decisions are made by assistants or nurses !
There is often poor communication between the clinic's staff members , who may end up providing contradictory information. The patient's expertise and intelligence is never respected; and most patients end up feeling patronised.
This seems to be true in very large clinics - and in small ones as well.
Thus, in some places, the gynecologist ( who is not an infertilty specialist) will do the superovulation and ultrasound scan monitoring; and then refer the patient to an IVF specialist for the egg collection. While satellite IVF clinics do work well , this is true only when they are tightly controlled and have strict protocols which are closely followed. Unfortunately, when gynecologists do an "occasional" IVF treatment every week or so, they often end up doing a major disservice to their patients , because they do not have the skill or expertise to treat them properly !
This is also true for centers which depend upon a "travelling embryologist" to do the ICSI treatment procedures. While these embryologists are very skilled and in great demand , it's hard for them to be in two places at one time. This means that they are often travelling from center to center, all across the country, and can only be in one center for about 48 hours. This means that the egg collections have to be done in this 48 hour window - and while about 80% of patients will grow eggs at the expected rate, this is not a good idea for older women or women who are poor ovarian responders, who need much more individualised treatment protocols , tailored to their body's needs.
The same criticism is true for the clinics which are run by "big-name" IVF specialists, who fly down from out of town to do the egg collections or embryo transfers once every month. The treatment protocols are monitored by remote control - but as any honest IVF specialist will tell you, this is suboptimal, and not in the patient's best interests !
Similarly, even in some very large IVF centers, the andrologist is available only once a week . This means all the TESE and PESA procedures have to be done on this one day - and the sperm are then frozen and used later for the ICSI procedure . This is not something which is in the patient's best interests, because the survival after freezing testicular sperm in men with partial testicular failure can be very poor !
The truth is that many IVF clinics today are run as commercial enterprises, to maximise profitability, rather to to maximise success rates. Ideally, you should look for an established clinic, which provides comprehensive care facilities under one roof, 24/7 !
Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !