Thursday, October 09, 2014

How some Indian doctors exploit the ignorance of IVF patients


For lots of gynecologists , IVF seems to be an extremely lucrative super-specialty , which is why many of them in small towns are now starting their own IVF clinics . They attend a one-week training workshop to get a " diploma " or certificate ; buy equipment ; arrange for an embryologist and an IVF specialist to fly down from the nearest large city once a month , and start offering IVF to the patients in their own town. Patients are delighted, because now they don't have to travel long distances to do IVF, which means the treatment is affordable.

Now if their success rates were good, this would be perfect. However, the tragedy is that they often do a poor job at doing IVF. For one thing, they are not registered as an ART Clinic with the ICMR
( Indian Council of Medical Research, New Delhi) which means they are not authorized to do IVF.

Second, they batch their patients so that they can do the egg collection on the date the embryologist will be visiting their clinic. As one would expect, the pregnancy rate is dismal, given the fact that they do IVF on a sporadic basis; there is no quality control in place; they have to depend on external expertise ; and are forced to group lots of patients together on order to make it cost effective for them to fly the embryologist down and to pay for his services.

If you lump apples and oranges together , you end up getting fruit squash of poor quality. Some patients will grow eggs slowly while others will grow faster, but  because the embryologist is down for only 1-2 days, they are forced to finish treating the entire batch of patients within the limited amount of time the embryologist is in their clinic. The doctor is forced to manipulate the cycles , so as to time everyone’s egg collection on the same day. The problem is that it’s not  possible do this well for all the patients in the batch, with the result that the superovulation protocol is not optimized for each individual patient. While this may not matter too much for young women who are good responders, older women will often end up with few eggs of poor quality. The doctor will then advise them to use donor eggs ( and usually these are taken from the other women who are cycling at the same time, without their consent !)

Because the embryologist has to complete so many cases in a short amount of time , he’s often tired and fatigued. It’s not possible to offer blastocyst transfers , because the embryologist usually spends only 1-2 days in the clinic; the documentation is very poor; patients are not given photos of their embryos; and they are not able to freeze the supernumerary embryos, which are wasted or donated to other patients ( without the patient’s consent).

Even though the pregnancy rate in these satellite IVF clinics is poor, they use various clever tricks to ensure that they don’t lose their patients to better equipped IVF clinics in the larger cities, even though these usually have much better equipment; a full-time embryologist; and a much higher success rate.

Because they live in the same town as the patient, they have a personal relationship with the patient, and they exploit the poor patient’s ignorance. Because patients are so emotionally vulnerable , it's easy to take them for a ride.

Thus, they scare patients by telling them it’s a bad idea to go to a IVF clinic in Mumbai. These are some of the flawed arguments they use.

1.    If you go to Mumbai, when you travel back after your transfer, your embryos will fall out of your uterus and you will never get pregnant, because you need strict bed rest after the embryo transfer.
2.    If there is a complication after your IVF treatment, how will your Mumbai doctor be able to help you ? They scare them with tales ( many of which are fictitious) of patients who have had problems after taking IVF treatment in other cities
3.    They claim that their success rates are as high as those of Mumbai clinics – and it’s easy to fool patients with these tall claims, because patients don’t demand proof.
4.    They hold on to their patients even after an IVF failure, by telling them that it’s better to do IVF cycles back to back, as this will increase their chances of succes.

It’s easy to fool some of the patients some of the time, but when patients find out that the information which was given to them was inaccurate , they are angry and resentful – and all IVF doctors end up getting a bad reputation.

IVF patients need to insist that their IVF clinic is registered with the ICMR before they agree to sign up for IVF treatment. While this is not a guarantee that the clinic has a high success rate, at least they know that the clinic has been inspected by a regulatory authority, which means it meets at least the basic standards needed.

Want to be sure you are getting high quality IVF treatment ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion,  so I can guide you!






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