Saturday, April 18, 2015

Failed IVF implantation - what should you do when all the results are normal ?


A failed IVF cycle cause a lot of anguish, both for the patient and for the doctor.  It's very frustrating when the cycle fails, and the first question the patient asks is - Why did it fail, doctor ?
Doctors are under a lot of pressure to answer the question, which is why they order a panel of tests to try to pinpoint why the embryos did not implant.

Sadly, the truth is that our tests are of very limited use in this setting. We do know that the commonest reason embryos do not implant is because they have genetic defects within them, which cause them to arrest. This is Nature's defence mechanism, to prevent the birth of an abnormal baby.  However, the genetic tests we have available today are quite crude.  Thus, tests such as PGS/CCS/NGS only allow us to count the number of chromosomes - we cannot analyse defects at the gene level as yet.

The big danger is that testing is not benign . Great potential exists to harm the patient by doing unnecessary tests, many of which produce false positive results. Thus, doctors will do a test for TB PCR, and "treat" completely normal patients with nine months of toxic drugs .  Others will check for " NK cell activity" and treat patients with expensive IV immunoglobulins, of unproven efficacy. Our first sacred oath as physicians is to “do no harm,” and we should approach such " therapies " with skepticism. A " pseudodiagnosis " can end up wasting a lot of time and money !

My advice to patients who have had a failed IVF cycle and have had a workup done by an IVF specialist with no clear answers is this:  Please accept the fact that we may not be able to provide you with answers. Instead of responding with despair, please rejoice that everything is normal . Count your blessings that there are no problems ; and understand that even though our technology is not very good for identifying problems, IVF is great for providing solutions by bypassing them . And just because 1-2 IVF cycles have failed does not mean that the next one will as well - all you need is patience, motivation and resilience. The rewards are well worth it !

Empower yourself and fight back , instead of depending on the hope that you will “get an answer” if you just find the “right doctor.”  Above all, realize that no answer is better than the wrong answer !

Not sure what to do after your failed IVF cycle ? 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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