Friday, November 28, 2014

The importance of documentation in an IVF cycle


IVF cycles don't always go as planned, and this can be frustrating for both doctor and patient. However, even if the cycle fails, all is not lost. The question we need to ask is – what went right? what went wrong ? what did we learn from this cycle ? and what can we do differently in the next cycle, to maximize the chances of success.

In order to answer these questions , we need reliable documentation. We need to know how technically proficient the clinic was and whether the quality of the treatment provided was upto the mark. Please remember that just because the treatment was done at a “good and reputed ” clinic doesn’t mean it was done properly. After all, all patients believe that the clinic they go to is good – otherwise they would never go there for treatment in the first place !

The technical minutiae of the cycle need to be analysed carefully.  Was the superovulation regimen appropriate ? Were the follicles monitored properly ? Was the HCG given at the right time ? Were the lab conditions good ? Were the embryos of good quality ? Was the transfer easy ?

In order to answer these questions intelligently, we need detailed medical information about the IVF cycle, which is why documentation is so important. Good clinics provide this routinely and proactively, but often you as a patient may need to insist on getting copies of your medical records. Remember that your records are your property and that you have paid for these !

You need images of your ultrasound scans, so you can see how many follicles you grew. You don’t need to insist on images of every scan, but it’s useful to have pictures of the mature follicles before the hCG trigger was given . You should also ask for an image of the scan after the collection is over, as this will prove that all the follicles present were aspirated properly. While egg collection is usually an easy procedure, sometimes it can be technically difficult ( because of obesity or pelvic adhesions), as a result of which the doctor may not be able to reach the ovary and is therefore not able to collect any eggs at all. When all goes well, the images don’t matter, but if your doctor is able to collect only a very few eggs even though you had a large number of follicles on the scan, this means that you need to find a more experienced doctor , who is an expert at doing egg collections ( for your next cycle)

If the doctor tells you all your eggs are immature or poor quality ( a reason many doctors will trot out to justify IVF failure), then you should insist on photos of your eggs, so you can get a second opinion from a specialist.

Similarly, if the doctor is not able to find any sperm when doing a TESE , he should give you photos of the dissected tissue as seen through the microscope. If this shows that he was able to recover adequate testicular tubules and there is lots of tubular content, then you can be reassured that the procedure was carried out properly and that the failure was not because of poorly performed surgery.

The most important documentation every IVF patient should routinely demand is photos of your embryos. After all, if you have good-quality embryos , a lot of the other stuff doesn't matter at all.

It is true that if your cycle is successful, then all the documentation is of academic interest ( though you can use it later on to show your child how hard you had to work in order to become a parent !)  However, if your cycle fails, then high quality documentation  can make a world of a difference in helping you to decide what to do next. Since you cannot predict in advance whether your cycle will fail or not, you need to collect your medical records proactively, while the cycle is going on.

Remember that these records are invaluable if you need to change your doctor. These images will allow the doctor to learn from your earlier cycle, so he can make intelligent decisions as to what changes he needs to make in order to improve your chances of getting pregnant.

Why should patients bother about all these technical details ? Isn’t this the doctor’s job ? The sad reality is that lots of IVF doctors don’t bother to share information with their patients. This is why patients need to take a proactive approach  ! You need to take an intelligent interest in your treatment to make sure that you know exactly what's going on .

Sadly, when things don’t go well, a lot of doctors become very defensive . They try to hide stuff , and refuse to be honest and transparent. They provide specious excuses, by saying that it’s “not clinic policy” to give the patient their medical records: or that they don’t take embryo photos as this may damage the embryos ! This is ridiculous and unacceptable . Embryo photos are basic medical documentation , and IVF medical records need to be provided to all patients.




Need help in making sense of your IVF records ?  Please send me your medical details by filling in the form at http://www.drmalpani.com/second-opinion so that I can guide you better !






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