Monday, June 30, 2014

Bouncing back after a failed IVF cycle


A failed IVF cycle causes a lot of heartburn – for both patients and doctors. There is a lot of grief , acute short-term pain and lots of people start playing the blame game. Was the doctor negligent or
incompetent ? Or did the patient fail to follow the medical advice given to her ?

The truth is that there is a lot we can learn from a failed cycle , and this is why it's important to create a framework , so that we can analyze the failed cycle and increase the chances of success for the next attempt.

Basically, the problem could be either with the clinic or with the patient . I understand this is an oversimplification , but we can use this simplified model so we can drill down intelligently. If the problem was because the clinic was poorly equipped or the doctor was not experienced, then this is an easy problem to fix by just changing the clinic for the next cycle. However, many cycles will fail inspite of the physician doing everything humanly possible and providing the best medical care .

Unfortunately, patients have a hard time pinpointing what the reason for the failure was – especially if this was a result of medical incompetence ( for example, an inexperienced embryologist who ends up killing many eggs while doing ICSI) . The doctor will do his best to hide the truth,  and will try to cover up ( for example, by saying the sperm were of bad quality , and were not able to fertilise the egg !)

This is why openness and transparency are so important in an IVF clinic. It’s true that patients are upset when the cycle fails , and doctors don’t like having to handle angry and tearful patients. However, when the physician refuses to meet them or discuss the reasons for the failure or provide intelligent information as to why the cycle failed , this angers the patients even more. They suspect the doctor is hiding the truth from them.

In fact, a failed cycle can actually be an opportunity for a good doctor to create even more trust in the patient . He should be willing to analyze exactly what happened and why, so he can discuss the next action steps with the patient. This is why good documentation, including embryo photos ( which should be provided routinely and proactively at the time of the embryo transfer) are so important.

Sometimes the problem is a biological problem, such as poor egg quality. In these patients, no matter how good the clinic, the chances of being able to create good quality embryos are slim. This is why counseling patients honestly before the cycle starts is so important, so that they have realistic expectations of what the technology can do for them.  Sadly, doctors often overpromise at the time of the first consultation, because they want the patient to come to them for treatment, as a result of which they quote highly inflated success rates.

However , biology being what it is , sometimes the unexpected does occur, and even when the doctor has certain expectations , these don't always pan out . In life, we need to deal with some of these ups and downs . The best way of doing so is by being frank and forthright.  A good doctor will say – This is what we expected, and this is why we expected this; however, this is what actually happened, and these are the possible reasons for this. Based on this analysis, this is what we can do differently the next time .

One option of course is to change the clinic, but this is not always the right choice and should not be your knee-jerk response just because you are upset the cycle has failed. If you are happy with your doctor and the way he has treated you, you should continue with him – after all, he is likely to be more incentivized to try harder the next time around !

Not sure what to do after your IVF cycle had failed ?  Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly !







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