Monday, March 02, 2015

IVF outcomes - skill, effort or luck ?


People often wonder what makes for winners , for example, in tennis. Does someone become a champion because he has special skills which he’s honed over years thanks to a lot of hard work ? or is it mostly a matter of luck ?  It’s often a combination of both, and this is equally true for an IVF cycle as well. The truth is that to win , you need both skill and luck. Some things are in your control , and some aren’t – and what you cannot control , you put down to fate or chance or destiny.

When an IVF cycle succeeds, IVF doctors are very happy to take the credit for the success, as they should, as they do deserve at least a part of it. The reality , however, is that skill is necessary, but not sufficient.

IVF doctors do need to become experts at superovulating the patient ; doing the egg retrieval ; providing the right lab conditions , so we can create good quality embryos ; and then transferring these smoothly into the uterus. This requires skill, and this skill can be polished over time. It’s important that patients realize that there are differences in skill levels between IVF doctors , so that they can pick the one who is the most technically accomplished. However, skill can only take you so far in an IVF cycle. Once the embryos have been created and transferred into the uterus , the luck element kicks in. We are now talking about a biological process over which doctors and patients have no control.

Thus , when an IVF cycle succeeds , it needs a combination of both skill & luck. Of course , when it succeeds no one really talks too much about the luck element, and everyone is very happy patting themselves on the back ! The doctor is pleased because he’s done such a great job , and the patient is very happy that she has been so smart in choosing the right doctor.

The converse is equally true , so that when the cycle doesn’t work , it is again possibly because of a combination of a lack of skill and bad luck. This means the IVF failure could be because the clinic was not very good , as a result of which the embryo quality was poor . On the other hand , the clinic could be extremely skilled and create good quality embryos , but after these were transferred , the patient wasn’t lucky, as a result of which the embryos did not implant.

Now this demarcation between skill & luck is a line written in sand, and it’s very hard to determine how much of it is luck and how much of it is skill . It’s partly because of this difficulty in differentiating between the two that some patients will get fooled by bad doctors . Even though their skill level leaves a lot to be desired , they will get lucky every once in a while, so that they can tom-tom these successes. However, they blame all the IVF failures on the patient’s bad  luck.

Patients need to understand that the key different between skill and luck in an IVF cycle is embryo quality. Clinics which make good quality embryos are skilled clinics. Clinics which fail to do so are obviously those which are lacking in skill. IVF patients need to learn to focus on those factors which they can control (selecting a clinic which is skillful) rather than worry about the luck factor , which is not in any one’s control !

And where does the effort come in ? This is the patient's contribution to IVF success.  Patients need to put in effort in educating themselves, so they can select the best doctor and monitor their cycle, to ensure they are getting the best medical care ;  and they need to have the stamina and determination to repeat cycles, if needed.

If you follow this process, you will have peace of mind you gave IVF treatment your best shot, no matter what the final outcome ! What more can a human being do ?

Want to improve your chances of IVF success ?  Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better !

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