Monday, April 13, 2015

Failed Implantation - the wastepaper basket diagnosis


When patients come to me for a second opinion after failing an IVF cycle in another clinic , the first question I ask them is - What did your doctor tell you as to why the cycle failed?  I get lots of different answers.  Some of them say that the doctor never bothered to explain ; or that the doctor never met us after the failure. However, the commonest answer is - The doctor told us the reason for the failed IVF cycle was failed implantation. 

Now, this is  a complete non sequitur.  All the doctor has done is use a fancy medical label in order to pretend that he has made a " diagnosis" .  Actually, this label is a cover up for our ignorance.  Failed implantation is just a descriptive term for the fact that the patient did not get pregnant after the embryo transfer because the embryos didn't implant.  It really does not tell us why the embryos didn't implant ! Did the doctor feel the embryos were of poor quality?  or that the endometrium was too thin?  or was the embryo transfer technically difficult? 

It is very easy to fob off poorly informed patients with these fancy medical terms . When a doctor uses medical jargon like this , he positions himself as an expert and deliberately tries to distance himself from the patient, so as to tell the patient - I am the expert, you're just a patient and you won't be able to understand all the complexities as to why the failure occurred, so don't ask me pointless questions because the answer will just go over your head. Just let me do what I think is right for you , and don't bother me with too many questions. 

I think this is a very immature approach . Doctors need to level with their patients , and it's perfectly fine for doctors to be honest and tell patients that we don't know why the embryos failed to implant, even though they were of good quality and your uterine lining was fine. After all, medical knowledge has lots of lacunae , and technology has its limitations . We are still not capable of answering these questions, even though we'd love to be able to to !

A more truthful analysis would be -  Let's review your cycle together. These are the things which went well, and these are the things which didn't go well. Therefore , we will make the following and changes in your next cycle , so as to maximise your chance of getting pregnant.  Patients appreciate being treated with respect as intelligent adults by their doctor and if doctors learn to do this, they will find their patients are much more loyal and faithful to them.

Need help in making sense of "failed implantation" ? 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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