Thursday, March 14, 2013

What went wrong ? Why did the IVF cycle fail ?

When an IVF cycle fails , the first question the patient asks the doctor is  : What went wrong ?

This can be quite an irritating question for the doctor because the reality is that even in a perfect IVF cycle , where everything goes right , the success rate will be less than 50 percent. However, when the patient chooses to phrase the question in this particular manner, it suggests he is implying that the doctor was incompetent ; or negligent ; or did something incorrectly ; or wasn't proficient enough. This upsets the doctor and sometimes doctors start getting defensive. Rather than giving the honest answer that we do not know why one particular cycle succeeds and why another one fails , they will order a battery of very expensive tests , to try to pacify the patient that they are on a quest to find the answer to this unanswerable question.

Mature doctors will sit down and explain to patients that we really don't have the technology to determine what happens to the embryo after we transfer it into the uterus. This is hardly surprising,  given the fact that we are transferring a microscopic ball of living cells inside the uterus. Human reproduction remains an inefficient enterprise , whether it’s being assisted in the clinic, or whether it’s being done in the bedroom.
However , not all patients are mature enough to understand the limitations of medical technology and science. Rather than explain the limitations of our science , it's much easier for the doctor to order a battery of tests. This often pacifies the patient , who thinks that now the doctor is on the right track ; and once she has figured out the abnormality and treated this, she will achieve success.

This is delusional thinking. After all , if there was a test which could provide this information , then every sensible IVF doctor would do it before starting the first IVF cycle itself. Why would they wait for failure to order the test ? After all , we don't want any of our patients to fail ! I’d be very happy if all our patients got pregnant in the first cycle itself. These happy patients would refer lots of other patients to me, keeping me extremely busy - and I would not have to answer questions such as – Doctor, What went wrong ?

However, because patients aren't willing to listen to the truth , doctors sometimes resort to manufacturing answers. This is actually a disservice to the patient , who ends up wasting a lot of time and money chasing red herrings , and not getting any closer to their goal of having a baby . Patients need to do their homework  before starting IVF, so that even if the cycle fails , they don't go to pieces and start looking for a scapegoat. They need to understand that even if nothing goes wrong, not every IVF cycle will end in a baby !

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