Wednesday, September 17, 2014

The IVF coverup



I just saw a couple who had done IVF earlier at another clinic. They were told that their cycle failed because their embryos were of poor quality - and that the reason for the poor quality of their embryos was either that their eggs were not good enough, or that the sperm had a lot of abnormalities.

They were advised that they need to use either donor eggs or donor sperm. The moment the doctor blames abnormal sperm as being the reason for poor quality embryos, this should raise a red flag that you are getting poor quality advise . The fact of the matter is that no matter how poor the quality of the sperm, if ICSI is being done in a high quality lab by a skilled embryologist, you should good quality embryos.

Abnormal sperm morphology or high sperm DNA fragmentation are very rare causes of poor embryo quality, and if your doctor trots these out as the reason for your ICSI failure, then there is a high chance that a coverup of the truth is in progress.

While it is true that poor quality eggs can result in poor quality embryos , it is also equally true that often it’s poor IVF lab conditions which cause poor quality embryos , especially in a young woman with a normal AMH level, a good antral follicle count and a good ovarian response.

It’s possible that the embryologist is not experienced; or that the incubator doesn’t function properly ; or that the culture medium being used is substandard.  Unfortunately, many labs do not follow basic quality control standards, and most clinics are pretty much free to do what they like, since there is no regulation or supervision.

This is why, rather than be honest with the patient and frankly admit that the reason the embryos were of poor quality was because the lab was not good enough, IVF doctors need to be creative and manufacture reasons for why the embryos were of poor quality . They can get away with this because there is a complete lack of transparency about IVF treatment . Most doctors don't even bother to tell patients how many follicles are growing on the ultrasound scan ; what their sizes are; or how many eggs were retrieved. They hide even basic information, such as how many embryos were formed, or what their quality is, by refusing to give them photos of embryos .

This means patients are pretty much at a loss , and are pretty much forced to accept whatever their doctor chooses to tell them. When they have poor quality embryos and then hunt for a second opinion , they then find out that their doctor wasn’t forthright or straightforward. They are understandably  upset , but once they have lost confidence in one IVF doctor, their confidence levels in all IVF doctors goes for a toss and they are very reluctant to try another cycle.

This is why patients need to do their homework proactively and learn to ask high quality questions before starting the cycle. While the outcome is always uncertain , patients need to be sure that the IVF clinic they select is following the right processes properly and that they will share information with them proactively.

Many doctors refuse to answer the patient’s legitimate questions by airily dismissing them. “ You don’t need to worry about all these details. They are too complex, and you will not understand any of it, so why bother ? We doctors know exactly what we are doing, and you just need to trust us !”

Patients are overpromised success when they first attend the clinic, because the doctor wants them to sign up for an IVF cycle. However , when the cycle fails, the doctor becomes a completely different person. He often blames the patient’s eggs for the failure, and patients can't understand why the doctor is now saying something which is so diametrically different from what he did when they started the cycle . Because of these conflicting messages, they lose confidence in IVF clinics, and this is why IVF clinics end up getting a bad reputation.

It’s easy to understand why doctors are very reluctant to tell patients the truth when they think there has been a problem with the quality of care they provided . It’s hard to tell a patient – I am sorry, you didn't get pregnant because our IVF lab wasn't good enough !  However, patients are stupid, and doctors cannot fool all the patients all the time. They will check with other patients and with the clinic staff as to how many patients got pregnant, and when the doctor tries to cover up the truth , they can smell that something fishy is going on. When they do find out the truth, they are very resentful and angry that the doctor lied to them.

Are you worried that your IVF doctor is not being honest and open ? 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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