The commonest question patients ask me before starting an IVF cycle is, "What are my chances of getting pregnant?"
For them , this is a key question , because that's going to help them decide whether to go ahead with the IVF cycle or not; and which IVF clinic to do it at . Unfortunately, it's the most difficult question to answer truthfully ! They are asking me to predict what the outcome of the treatment is going to be , and that's really not possible for anyone to do. I can talk to them about the IVF process and how we can take good care of them, but how can I predict what's going to happen for an individual patient ? What I can share with them is success rates for the entire clinic , and I can say our pregnancy rates for women less than 35 for whom we transfer two top quality blastocysts is 46%.
However, what does that mean for them as an individual? Very little, because we don't know how many blastocysts we will create for them, or what their quality will be, before starting the IVF cycle. This is not something I can predict accurately , because I don't know how many eggs they will grow; how many embryos they will form ; or what the quality of their embryos will be.
When I cannot provide a clear answer, some patients get upset because they feel I'm evading the
issue , or that I'm not being up front and honest. The reality is that the quality of an answer depends on the quality of the question. Patients need to understand the uncertainties involved with a biologically complex treatment like IVF, because there are so many unknown variables.
This is exactly what the law of small numbers predicts. While we know that out of a 100 patients we treat, 46 will get pregnant when we transfer two blastocysts, we don't know what will happen for the individual patient who's sitting in front of me . And she really doesn't care about what's going to happen to the other patients in my clinic - she only wants to know what's going to happen to her, and this is the one answer which I can't give her.
I think patients need to understand the limitations of a single number which is supposed to predict their chances of success. The number is a gross oversimplification, which is why we try to educate them , and explain to them what the pitfalls of quoting a number are. Just providing a simple number is not enough , and some unsophisticated patients will try to compare the " chances of success " numbers which doctors quote to them, without realizing how meaningless this entire exercise can be.
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !