Saturday, January 04, 2014

Preventing IVF failure


While it is true that not all IVF cycles will succeed, the good news is that a lot of IVF failures are
avoidable !  What can you do as a patient to prevent these failures ?

Let’s start by acknowledging that not all IVF clinics are equal. Some of them are poorly equipped ( and don’t even have a reliable 24-hour electric supply); some of them don't have enough experience and expertise in actually doing IVF, and have to depend on the expertise of traveling embryologists and doctors to do the procedures for them. Many have poor quality control measures , and since the quality of the IVF clinic can make such a big difference to the outcome of the IVF cycle , the most important thing you can do to maximize your chances of success ( and therefore reduce your chance of failure ) is by spending enough time and energy in selecting a good IVF clinic . This is easier said than done , because every patient goes to a clinic which they think is good ! How do you check whether the IVF clinic you have selected is truly good or not ? This is why Information Therapy is so important ! Not only do you need to do your homework before starting the IVF cycle , you need to be actively engaged during the IVF cycle itself , to make sure that things are going according to plan ; that your injections are being given properly; that your follicles are going well on the ultrasound scans; and that the clinic will provide you with photos of your embryos at the time of your embryo transfer , so that your documentation is complete. This will ensure your treatment is high quality; and this openness and transparency will increase your confidence levels that you are in good hands.

One of the reasons for avoidable IVF failure is errors – and while some errors occur because the medical team maybe incompetent, overworked or fatigued , others occur because the patient fails to do what they are told to. Poor patient compliance is a particularly poignant cause of IVF failure, because it is so easy to prevent. Sadly, we still see patients who mess up their IVF treatment, because they do not mix their medications properly  ( for example, they do not realize that they need to dissolve the active HMG powder in the solvent; or they fail to take their HCG trigger shot at the right time, as a result of which the doctor is not able to collect any oocytes during the egg retrieval.  A particularly tragic event IVF clinics see occasionally is when the husband is not able to produce a semen sample on demand, at the time of the egg collection. This often means  that the entire cycle gets wasted, because the clinic does not have the expertise to freeze the eggs or do an emergency electro-ejaculation or TESE. This is why it’s a good idea to freeze the man’s sperm sample prior to starting IVF, so this can be used as a back up, if needed. While some clinics do this routinely, active patients may need to take the initiative and proactively ask the doctor to do this for them.

It is true that IVF treatment can be complex and it’s easy to get confused The good news is that clever technology can help you to remain in control , so you do everything you are supposed to do . For example, the free IVF app for android smartphones at www.myfertilitydiary.com can help to remind you of what medicines you are supposed to take; and when !

Some errors may occur because of the lack of coordination between the nurses and doctors; or because the junior doctor is inexperienced. This is especially likely to occur in clinics which batch patients, and have to depend upon an external expert to do the actual IVF treatment. For example, the doctors may not give you the right dose of HMG injections for  superovulation, as a result of which you may grow few follicles; or the doctor may not have the experience to do the egg collection properly, as a result of which they may not retrieve all the eggs in your ovaries. This is an especially vexing problem with PCOD patients, and most doctors are not able to do a good job with superovulating them. They are so scared that their patient may develop the complication of OHSS, that they often end up mistiming the HCG injection, as a result of which they are able to retrieve few poor quality eggs , which result in IVF failure because the resulting embryos are of poor quality.

The biggest problem is that when the IVF cycle fails because of an error on the part of the medical team, they will usually try to cover this up, as a result of which the patient never finds out the truth !

This is why you should take an intelligent interest in your treatment . You should know exactly what the plan is ; and whether you are growing your follicles as expected. Insist on seeing the ultrasound scans; and ask for embryo photos. Engaged patients are empowered and get better care, because they keep the medical teams honest and on their toes !

Of course, just becoming an expert patient is no guarantee that your cycle will not fail. It’s important to be prepared for failure, so you become emotionally resilient, and can cope better with the IVF roller coaster ride. If you have realistic expectations, including a Plan B in the event of failure, you will be able to bounce back, no matter what !

The good news is that while you cannot control the outcome, you can control the process . Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best.


Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !








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