Wednesday, July 27, 2011

IVF, science and pseudoscience

Medicine is not an exact science. It’s not possible for us to predict what the outcome of an IVF cycle is. While we are very good at making embryos in the lab, once we transfer the embryos into the uterus we still cannot predict which embryo will become a baby & which one won’t. When an IVF cycle fails , especially after the transfer of Grade A embryos, the first question the patient is going to ask is - Why did the cycle fail? When this happens , a lot of doctors become very defensive because they feel the patient is blaming them for the failure. This is why they are reluctant to tell the truth , which is - We really don’t know because we don’t have the technology to be able to answer this question. This is the honest scientific answer ! After all, human reproduction is an inefficient enterprise, whether it’s in the lab or in the bedroom !

A lot of doctors will provide pseudoscientific explanations in order to keep the patient happy. Partly they do it in order to protect themselves ; and partly they do it because this is what patients expect. Patients don’t want to be told that doctors are human and that there are lots of things they don’t know. Patients want answers because they feel doctors are experts to know everything about what’s happening. This is why doctors will then spend a lot of money doing expensive tests such as immune testing, endometrial function tests, and tests for tuberculosis by doing PCR on an endometrial biopsy in order to keep their patients happy.

While some of these tests may be useful in a research setting , the honest truth is they are not very useful in a clinical setting , because we still don’t know how to interpret these tests for the individual patient. Then why do doctors make patients do these expensive tests ? For one, doctors are pleased , because they’ve done some additional tests and found some additional information ( even though it may be clinically useless). Patients are happier too , because they feel the doctors are getting to the root of the problem and after getting the computerized result of an expensive test, he finally knows what’s happening, so he can fix it for the next attempt ! Unfortunately, most of these tests don’t provide any useful results , and they actually can be harmful to the patient.

This is because when the results are abnormal , the doctor is then obliged to try and so something in order to “ fix “ the problem. All this over testing leads to over treatment - none of which actually helps to improve outcomes ! This is where the difference between science and pseudoscience comes in. Honest doctors will tell the patient that we have now reached the limit of our technology. We don’t have very good answers because it’s hard to track the fate of a microscopic ball of cells once it’s transferred into the uterus. There are certain tests which are useful on a research basis and not a clinical basis ; and if the patient still wants these tests done, we can do them but we are not certain whether the results of these tests will help us to improve the outcome. Most patients are intelligent and understanding. They know that doctors are not God , and if the doctor takes the time to explain things to them properly and don’t insult their intelligence by talking down to them, they will accept the limitations of medical science , and will be happy to continue with their next IVF cycle. However when doctors don’t take the time and trouble to counsel their patients , they get fed up and frustrated , causing a lot of unhappiness both for patients and doctors .

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