Wednesday, August 31, 2011

I was just talking to a patient whose wife had failed an IVF cycle

I was just talking to a patient whose wife had failed an IVF cycle . She had had a poor ovarian response and he wanted to know whether it was worth trying another cycle again on not.
His question was simple . Is it worth subjecting her to the pain of an IVF cycle ? Do we have a chance of success ? Or is it futile ? Are we just breaking our head against a brick wall . He wanted my opinion, based on what we’d learned from the first IVF cycle. He loved his wife a lot , and was very protective of her. He didn't want her to go through the pain of another IVF failure , and while he understood that there were no guarantees, he still needed advise as to whether it was sensible to try again.

The major problem with an IVF cycle is not the physical pain of course - it's the emotional pain of failure, because there's so much riding on the outcome of an IVF cycle.

It's always hard to answer these questions because they involve so many intangibles . There are some decisions which doctors can't make for patients , so I tried my best to counsel him and put things in perspective.

Every IVF cycle involves a certain downside - but , there is an upside to it as well ! While it was true that his chances of success in terms of having a baby were not very good , often the one thing an IVF cycle provides is peace of mind that you've done your best , so that you have no regrets afterwards
It is true that there's a lot of emotional pain when the IVF cycle fails . This is acute pain , which can be very hard to manage both for the wife and for the husband – and often you feel that the world has ended and it can be hard to cope with this.

However, it’s also true that the infertile woman goes through emotional pain every time she has a menstrual cycle and she fails to conceive each month. Of course, the difference is that this is a chronic low low-grade long-term pain as compared to the acute pain of IVF failure, which is of a much greater degree.

What’s true is that how each person copes with the pain of an IVF failure varies remarkably ! Some patients are very resilient and find it easy to move on with their lives , whereas others go to pieces completely . Not only does this depend on their emotional reserves and personality , it also depends on how many external pressures they are subject to , and whether they doing the IVF treatment to keep themselves happy or to keep their mother-in-law happy !

I told him that this was a decision both of them would have to make , but in our experience doing a second IVF cycle is much easier because patients know exactly what they are going in for ; and because they've experienced failure the first time , their ability to deal with this the second time is a little bit easier, because they have more realistic expectations !

Enhanced by Zemanta

4 comments:

  1. Anonymous2:04 PM

    Dear Dr,

    How will you describe a poor responder? For my first IVF I produced 3 eggs but I am on the least gonal F dose (75iu). For my 2nd IVF I produced 7 eggs (175 iu gonal F was used). Am I a poor responder? I there any other reason for a woman to be a poor responder other than low ovarian reserve?

    ReplyDelete
  2. A poor response could be because of poor ovarian reserve; or because of poor superovulation ( poor quality of drugs; inadequate doses of drugs; mis-timed HCG shot for triggering ovulation)

    Can you please test your antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

    What’s your AMH level ? Read more at www.drmalpani.com/amh.htm

    We look forward to helping you to have a baby !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    My Facebook page is at www.facebook.com/Dr.Malpani

    You can follow me on twitter at http://twitter.com/#!/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete
  3. Anonymous1:56 AM

    Dear Dr,

    My AMH level is good once it is 3.5 and once it is 6.7 and so on ( on a scale of 1-8). I have never asked for AFC count. I will do it.

    One more question if I have an AFC of only 5 does it matter what gonal F dose is given to me? Even if they give me 450 iu gonal F, I will develop only 5 follicles, then why cant I be given a low dosage since the drugs are so expensive? I hope u got my point :)

    ReplyDelete
  4. Excellent question. There are some doctors who will treat patients with poor ovarian reserve with minimal stimulation IVF. This does help to reduce the cost - but the success rate is also lower. The key question is - is the success rate lower because these are poor prognosis patients ? And can we improve this with more aggressive superovulation ?
    We still don't know - and every doctor has a different approach !

    Dr Aniruddha Malpani, MD
    Malpani Infertility Clinic, Jamuna Sagar, SBS Road, Colaba
    Bombay 400 005. India
    Tel: 91-22-22151065, 22151066, 2218 3270, 65527073

    Helping you to build your family !

    My Facebook page is at www.facebook.com/Dr.Malpani

    You can follow me on twitter at http://twitter.com/#!/drmalpani

    Watch our infertility cartoon film at http://www.ivfindia.com

    Read our book, How to Have a Baby - A Guide for the Infertile Couple,
    online at www.DrMalpani.com !

    Read my blog about improving the doctor-patient
    relationship at http://blog.drmalpani.com

    ReplyDelete

LinkWithin

Related Posts Plugin for WordPress, Blogger...