Saturday, February 22, 2014

Minimising the risks of IVF


The outcome of IVF , like any other biological procedure , is uncertain. The definition of risk is the possibility of an undesirable outcome , so patients need to evolve strategies which allow them to deal with the risks of IVF . There are basically two sets of risks. First, is the medical complications associated with IVF , which are basically the risk of ovarian hyperstimulation syndrome ( OHSS ) and that of multiple pregnancy . The good news is that both these complications can be prevented, which is why you should choose a good IVF clinic which is experienced in dealing with and managing these problems . These risks are easy to manage , because there are well defined medical strategies to deal with them. A good IVF clinic  will inform you about these risks , so that you can discuss them with your doctor.  Thus, one simple way of preventing multiple pregnancies is to do a single embryo transfer ( SET).

However, there are additional risks associated with IVF , which it's not possible for the doctor to control. This is where the role of the patient becomes extremely important . The major risk is emotional – the risk of having to cope with the fact that the IVF cycle may fail . Now a lot of IVF clinics harp about their success rates and reluctant to talk about their failures. However, remember that for every cycle that succeeds , there are cycles which fail. This is a fact of life which we can't afford to gloss over .

It’s important that patients come to terms with this . If you have realistic expectations, it makes it much easier to manage this risk.  Taking an ostrich in  the sand attitude and pretending that your personal chances of success are going to be 100% can only lead to heartbreak.  This is why information therapy is so important , so that you can prepare yourself for any possible outcome. Being mentally prepared for what you will do in case the cycle fails can only make you emotionally more resilient. A failed IVF cycle is not the end of the world and doesn't mean that you can never have a baby . It just means that this particular attempt has not worked, but hopefully you will learn from this particular cycle , and improve your chances of success for the next attempt. Remember that when we talk about IVF success rates , these are cumulative conception rates, over 3-4 cycles.

The most important thing can do to reduce your risk of failure is to choose a good IVF clinic , because the major difference between good clinics and bad clinic is the difference between their success rates . The problem is that's not really easy to get accurate figures as to what your individual clinic’s  success rates are – and what your personal chances of success are likely to be.  It’s often hard to make sense of these figures , because it's possible to game them. Even in countries like the US and the UK, which are required by low to report and publish their success rates, it’s possible for clinics to dress these up ( for example, by refusing to treat difficult patients; or by cancelling cycles for poor responders). This is why you need to use your common sense and use surrogate markers to judge a clinic’s success rates – especially in India, where clinics do not report their figures.

Since the major variable which influences IVF success rates is the ability of the clinic to produce good-quality embryos , IVF clinics which routinely provide you with photographs of your embryos are far more likely to have good success rates, as compared to those which don’t ( presumably because they have something to hide ?)

While it's true that IVF is be a complex expensive procedure , which is fraught with the risk of failure , it's also true that the upside is enormous because it's the one treatment option which gives you the best chance of having a baby . For lots of infertile couples , IVF is definitely a risk worth taking, but you need to go into this with your eyes wide open , so that you don't burn your fingers.


Need help before doing IVF ? Please send me your medical details by filling in the form at www.drmalpani.com/conversations  so that I can guide you better !

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