Tuesday, January 27, 2015

Is IVF the best path for infertile couples?

   
The two perspectives

Patients and doctors perceive illness and treatment from completely different perspectives. Let's look at infertility, for example. Most doctors look at the world through a biomedical perspective. They want to diagnose the problem, and then come up with solutions to help the couple to conceive. This is the traditional approach in medicine, where the first step is to make a diagnosis, and then devise a treatment plan. Text books will talk in terms of treatments based on correcting an underlying problem, and will usually offer a chain of treatments which progress from simple to complex, and less expensive to more expensive. This is the step-by-step care approach, which makes a lot of sense from a societal perspective.

However, the patients’ perspective is completely different. They don't really care as to whether the reason for not having a baby is low sperm count or blocked tubes. All they want is a baby, so they can move on with their lives.

This often creates a lot of tension between patients and doctors. From a patient's perspective, instead of wasting time, money, and energy on ineffective treatments which have a low success rate, it makes sense for them to move on directly to the treatment which gives them the best chances of success. Yes, I am referring to IVF – the final common pathway which allows infertility specialists to bypass all medical problems!

However, most doctors do not share this point of view. Many are not very empathetic and do not understand the emotional pain infertile couples suffer from. They would prefer taking a text book approach to the problem. Many are tied down by treatment guidelines published by gynecology societies or the government, which limits the options they can offer to patients. Furthermore, doctors often tend to be quite arrogant. Their approach seems to reflect that they know what's best for the patient, because they are the experts, and often end up not taking the patient's viewpoint into consideration at all.

IVF – The ray of hope

Let's look at a 35-year old couple who wants a baby. The couple is financially quite well settled, and now needs a baby to complete their life . Traditionally, doctors would do an infertility workup to find out what the problem is, and then start treatment to rectify the problem. Unfortunately, this sort of approach can be very time consuming, and not very efficient. Patients will often get fed up, as they simply do not have the time or energy to keep going back to the doctor for repeated follow-ups, all of which can exact an emotional toll. Not only does this aggravate the pain of failure but also leads to opportunity cost , and a waste of time. From a doctor's view point, this is par for the course. Yet, I feel doctors need to be more flexible, and tailor treatments to suit the patient's perspective.

For this particular husband and wife, the bottleneck is not likely to be the money but rather the time and energy they can devote to their dream project of having a baby. It would make much more sense for them to opt for IVF to maximize their chances of having a baby soon. I understand most doctors will consider this as being too aggressive and maybe overkill. In fact, I too shared the same view in the past. However, now I feel we should let the patients decide rather than make decisions for them. If the trade-off is between time and money, many will decide to go for the most efficient route. Even if it is more expensive, it may be the most cost-effective for them!

Not only are we saving the couple a lot of time by giving them a baby through IVF but we are also helping to improve the quality of their parenting, so that they can spend precious time with their baby while they are young and energetic, rather than waiting till they turn 40 and are then told to do IVF!
In a fee-for-service setting, I believe decisions about which of the available treatment options to select are best left to patients rather than to doctors. A good doctor will explain all the options to the patients, including the trade-offs involved, and then allow the patients to decide for themselves!

Unfortunately, especially in the UK, most general practitioners are not quite empathetic toward infertile couples. They end up wasting valuable years of the couple's life in ineffective treatments before referring them to a specialist. This culminates in years of wasted opportunity and heartburn for thousands of infertile couples, leading to enormous misery.

Do you think IVF is your best option ? 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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