I just saw a 28 year old woman with unexplained infertility. I am a conservative doctor and suggested that the logical treatment option for her would be intrauterine insemination ( IUI).
However, she was quite adamant that she wanted to do IVF. She had done her homework and knew that IVF had a much better success rate than IUI. Since it did not involve surgery or have any medical risks, she was sure IVF would be better for her, because she did not want to waste time.
" Why should I do a treatment which has a success rate of only 10% when I can go in for a treatment which has a success rate of 46 % ? I am paying for this myself, and my time is at a premium. I have only one life, and want to enjoy being a mom when I am young and have lots of energy. Both IUI and IVF involve coming to the clinic 6-7 times each month, and I'd rather select an option which would have a higher yield. I am the kind of person who flies first class - and IVF would actually be more cost effective for me !"
This was a woman who knew her own mind, and it was hard to argue with her logic. Money was not an issue for her; and she was well-read and well-informed.
This is a good example of IVF being done for patient reasons, and not medical reasons. I believe we should respect patient autonomy , and allow the patient to decide.
Will this lead to overtreatment ? Yes, but there are lots of advantages to this approach.
It saves the patient valuable time , because she'd rather focus on bring up her baby and moving on with her life, rather than making multiple trips to the infertility clinic !
This approach is quite ethical, because it put patients in charge of their treatment ( respects their autonomy) ; provides them the benefit of a higher success rate ( beneficence) ; and also has no risks or downsides ( non-maleficence) .
Is it ethical for me to refuse her request ?