Monday, July 20, 2015

Is IVF useful for women who have repeated miscarriages ?



Women who have had repeated miscarriages are often very frustrated . Not only are they extremely upset and unhappy with themselves , because their body doesn't work properly , but they find it very hard to get reliable medical advice . Each doctors gives them a different opinion; and websites will often provide diametrically opposite and contradictory information . Patients are completely confused and lost , and don't know whom to believe , and what to do next . A lot of them get paralysed , and many just give up.

Recurrent pregnancy loss is a very confusing problem , and we do not have the tools and technology to be able to pinpoint what the problem is for the individual patient . While we do know in general that the commonest cause is a genetic problem in the embryo , this is often very difficult to prove or to establish for an individual patient. This is why we often resort to empirical therapy - treatment based on experience with other patients , rather than on running tests for that specific patient , in order to try to find a specific diagnosis, because this is often an expensive wild goose chase, which provides no useful information.

Patients are extremely unhappy when we cannot provide them with a specific diagnosis . They feel that if we can't find the problem , we will not be able to find a solution . Fortunately , this is not true . While we are very good at being able to pinpoint problems , assisted reproductive technology today is very good at bypassing these .

We are not able to make a diagnosis for most patients who have had recurrent miscarriages . Their reproductive system is anatomically normal, as are their chromosome tests . We are completely in the dark as to why she is miscarrying , because our tests are fairly crude, and not precise enough.

Imagine the amount of stress the poor patient goes through ! She doesn't know whether she should try getting pregnant again , and is very scared even when she does get pregnant , because she is petrified that she will miscarry again. She not sure whether she needs treatment , and if so , what treatment she should take .

Different doctors advice different treatment options . Some talk about immune therapy , others offer surrogacy , while some state that using donor eggs is their best option.

Interestingly , for some of these patients, IVF with their own eggs can be a useful treatment option . This may sound counter-intuitive. After all, they are getting pregnant on their own, and do not have a fertility issue, so why should they spend money on doing IVF ? Isn’t IVF a treatment for infertile patients ?

Interestingly, IVF improves reproductive efficiency by telescoping time . In the natural course of events, she would produce only embryo every month , and some of these would be genetically abnormal. It would take her a long time to produce a genetically normal embryo , which would give her a healthy baby , because this is such a random affair. The beauty about IVF is that it allows us to create multiple embryos in one cycle .  We can help her to make 10 embryos in one cycle, and then allow them to compete amongst themselves , so that we can pick the best blastocyst, and then selectively transfer this in her uterus. Rather than adopt a hit and miss approach , which could consume a lot of time , we are helping her to maximize her chances of hitting the jackpot quickly , by resorting to IVF . Think of someone who's buying a lottery ticket . Rather than buy just one lottery ticket every month , over a period of a year , she could buy 12 lottery tickets in one month , and hope that one of the tickets she bought could be a winning one . Yes, it's true that this is a gamble . Whether she buys a ticket one at a time, or all at once , this will not affect the chances of selecting a winning ticket.  However, she can trade money for time, and save herself valuable time by having many embryos to select from on one 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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