The patient in front of me was extremely frustrated. She was now 41 years old, she had failed three IVF cycles, and was quite fed up of taking injections. She knew that her ovaries were small, her antral follicle count was low, her FSH was high, her AMH was low and that the odds were stacked against her . She wanted to know, “Should I try another IVF cycle or not, Doctor or am I just wasting my time. Should I just call it a day and forget about it?” And this, of course, is the million dollar question which every patient wants to know. Is it worth taking a gamble and trying one more cycle or should you just cut your losses and say, “Fine, I’ve done enough and I don’t want to try anymore”.
The trouble with this question is that the answer is not something which any doctor should give, because it's not just a medical question. It’s an answer which actually has to come within the patient’s heart herself. While I could tell her that the chances of a success were extremely low, this was stuff which she already knew, so she didn’t really want to hear that from me again. While it’s important that I be honest and truthful, I also don’t want to take a patient’s hope away . I don’t like being blunt because sometimes patients can misconstrue that as being uncaring and unkind. However, I couldn’t afford to sugar coat the truth and tell her that she had a good chance of success either. Now, this doesn’t mean that if she does a cycle she is doing anything wrong and neither does this mean that if she decides to stop, she’s making the wrong choice . It’s literally six of one and half a dozen of another and because this is not a medical decision, it’s not something about which I can tell her what to do. It’s a personal decision based on her choice, which is why she needs to make the call for herself.
Doing another IVF cycle wouldn’t be futile, even if she didn’t grow any eggs and even if she didn’t get pregnant, because it would provide that intangible peace of mind for herself that she’d done her best, so that at least she wouldn’t have any regrets later on in life that she hadn’t given it her best shot. And sometimes doing a cycle, even if it fails, allows people to move on with their lives so that they can then have clarity and start considering alternative options such as remaining childfree or adopting a kid, or consider using donor eggs.
This is why some of these decisions, because the consequences are so considerable and because they are so emotionally charged, are best taken by the patient herself , rather than allowing a doctor to decide. As a doctor it’s important for us to make sure that patients don’t have false hopes, so we try to keep them grounded in reality , but such important decisions should be made by patients themselves.
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