Tuesday, February 21, 2017

The embryologist - the unsung hero of the IVF clinic.


Lots of patients don't know how to evaluate how good or bad an IVF clinic is. This is hardly surprising , because when they go to an IVF clinic, all they do is see the doctor,  who is a clinician.

However , the real heart of IVF treatment lies in the IVF laboratory, where the embryologist takes tender loving care of your eggs and sperms , so that he can make beautiful embryos which the doctor can then transfer back into your uterus.

Sadly, most patients never get to see an embryology lab; and they never get to talk to the embryologist. They have no idea about how good or bad the lab is. Is it well equipped ? How good are the quality control standards it follows ? Does the lab have a full-time embryologist or not ?
It's a bitter truth that most patients still don't know that most IVF clinics in India do not even have full-time embryologists. The gynecologist basically sets up a lab , and then hires traveling embryologists who come and do procedures on an episodic basis.

Yes, they will get pregnancies , but the success rate will be low, especially for difficult patients . The poor embryologist is forced to do all the cases in 1-2 days. This means he cannot focus on quality control ; and since he leaves , he cannot stay on to freeze the supernumerary embryos, even if they are of high quality. This is the dirty secret behind why most IVF labs in India don't freeze their patients spare embryos, this reducing their chances of having a baby. The embryos are either discarded, or donated to other patients without the patient's consent !

This is why so many IVF clinics today are forced to cut corners. It's not because the doctor is bad, but because they do not have a good full - time embryologist to run their IVF lab.

Quite frankly, if I had to choose between a good clinic and a bad lab , versus a bad clinic and a good lab, I would rather choose a bad clinic with a good lab , because a good lab can compensate for a bad doctor. This is because what the gynecologist does in an IVF treatment cycle is usually very cut and dried. He simply follows a published treatment protocol , which is why there's not much to pick and choose between the medical treatment plan of most IVF clinics.

However, what the embryologist does in the lab makes a world of a difference, and a bad embryologist can butcher embryos by ill-treating them. Sadly, the poor unsuspecting patient has no clue as to why her embryos are always of poor quality . The doctor either blames her eggs or her husband's sperm, while the real problem is a poor quality lab!

Of course, your best bet is to find a good clinic with a good lab , as this will maximize your chances of getting pregnant . However, what happens most of the time is that patients unfortunately end up in bad clinics , who also usually bad labs, because they don't do enough IVF cycles. This is why they don't have enough experience because of an inadequate workload; and they don't have enough expertise, because they can't afford to employ a full-time embryologist. It's very hard to get skilled embryologists in India , because the training still leaves a lot to be desired. This is why most of them learn by trial and error , and aren't good at their job. This is why there is such a world of a difference between the success rates of good clinics and bad clinics.

Unfortunately, there's still a major lack of transparency as regards IVF treatment today. Most clinics don't even both to give a treatment summary to their patient, leave alone photos of their embryos ( which should be compulsory, because it documents that the lab managed to create high quality blastocysts).

The ICMR wants to start protecting patients by bringing in regulation , and it suggests standards which all IVF clinics need to follow . However, implementing this in real life is still going to take a long time. That's why the rule is caveat emptor - let the patient beware ! You need to do your own homework , and the best way of doing this is by making sure that the lab provides you with photos of your blastocysts routinely every time you do an embryo  transfer. This is the gold standard , and as easy way to check how good your IVF clinic really is !

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 !




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