Wednesday, April 16, 2014

Pushing patients into doing expensive IVF treatments


I received an interesting e-mail from a patient .

She wrote., “ I am currently pursuing IVF/ICSI/PGD/PGS eSET. Doctor performed one 'Endometrial Function Test' which determined 'Exteme Glandular Developmental Arrest' (aka 'Glandular Stromal Dyssynchrony') Treatment consisted of 3 consecutive months of 3.75 mg Depot Lupron, inducing menopause. After first failed eSET FET, my doctor is now pushing for gestational surrogacy, citing the 'GDA' as the primary reason why I will never carry to term. I am suspicious.”

As you can see , this is obviously a sophisticated , well-informed patient , who's done her homework . She is taking treatment at a modern, sophisticated , well-equipped , world-famous, " brand name"  IVF clinic in the USA , where her doctor has advised her that she needs surrogacy in order to have a baby. Fortunately, this patient is smart enough to realize that this is not good advice , which is why she asked me for a second opinion .

I can imagine how many other patients this particular IVF clinic must be taking for a ride, by coining all sorts of unscientific terms using pseudoscientific tests, in order to scare the patient and upselling them into doing expensive treatments.

While we talk about “ endometrial function tests”, the truth is that the endometrium is an extremely dynamic organ . We can easily can help the endometrium to grow properly , and “ treat the dyssynchrony “ by using estrogens. However by using medical jargon , such as “ glandular developmental arrest “ ( terms which even I find hard to spell and pronounce ), any patient is going to get intimidated . The doctor has folled her into believing that she has an intractable problem,  and would therefore be willing to do whatever the doctor advises.

The tragedy is that most patients are not sophisticated enough to understand what the doctor is saying. Many doctors take undue advantage of this information asymmetry and push patients into doing inappropriate treatment , because it is financially much more profitable for them .

By advising surrogacy , the doctor can make four times as much money as he would by doing an IVF cycle . Patients are often desperate and are happy to do what the doctor suggests. Similarly , lots of doctors suggest that patients use donor eggs , rather than try to do IVF with their own eggs, using alternative options such as aggressive superovulation or natural cycle IVF . While it’s true that using donor eggs does have a higher pregnancy, it’s also equally true that this option is much more profitable for the doctor. Most patients would much rather try at least once with their own eggs, rather than be pushed into using donor eggs.

It's sad that IVF clinics are not willing to put patient's interests first , and by coining all of these fancy medical terms and using all of these unproven experimental treatment, they push patients into doing treatment which may not be right for them .

The only solution to this distressing problem  is Information Therapy . Patients need to do their own research and then decide whether what the doctor is saying makes sense or not .

Not sure if your doctor’s advise is in your best interests or not ? 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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