Friday, December 01, 2017

Poor quality IVF treatment

I received this tearful email from a patient.

I have a very sad medical history .  I used to get extremely painful periods (I got my first periods at the age of around 14-15 years) where medical help was always required by me. The doctors in my home town could not understand the problem and we were completely relying on the best doctors of our city. I was treated for depression, epilepsy, abdominal TB, hormones, etc. etc. because they believed that my symptoms were similar to any of these ailments.
After years of treatment but no relief (around 11 years of treatment with no solid diagnosis, no reports nothing), I got married at the age of 28 and there after when I was not able to conceive my husband took me to SCI International Hospital in February 2016. After proper diagnosis they told us that I was suffering from endometriosis. I had my laparoscopic and hysteroscopic surgery in October 2016 at Indraprastha Apollo Delhi. I got my next periods in around Feb-Mar 2017 after surgery.
Thereafter it was followed by two IUI failures and two IVF failures. My last negative HCG report I received on 28th November 2017. My doctor says everthing was good. She said it was magical that I had good number of eggs during both my IVF cycles, with two Grade A and one grade B each time. So everytime they put in three embies in me and everytime it did not exist.
The doctor says probably it is not God's will otherwise they had tried their best. I am not much satisfied by blaming God and myself. If everything was good then why did I have so many failures. There must be some reason behind it? The reason is yet undiscovered. If the problem is with eggs then why did I get grade A embryos each time and if the problem is with uterus then even donor eggs cannot help me...
I strongly believe that if there is a problem, there will be a solution to it. The only thing is 'a right person who can given right suggestion is required'. I request you to kindly go through the reports that I am attaching with this mail and provide your valuable suggestions.
I replied, asking for more details about her IVF cycle, so I could offer suggestions. After all, I need more medical details, so I could guide her properly.

Can you send me more details about your IVF cycles ?
DO YOU HAVE PHOTOS OF YOUR EMBRYOS ?
You can see what embryos should look like at http://www.drmalpani.com/knowledge-center/ivf/embryos
What were the  meds which were used for
superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood at the time of the HCG trigger ? What was the endometrial thickness ?
How many embryos were transferred ?
What was the embryo quality ? 
Can you please send me the printed treatment summary from your IVF clinic ?
Her reply was

Thanks for your kind response. I do not have any photos of my embryos. Should I ask my doctor to share it with me? I mean I was not aware that photos of embryos are also taken during the treatment but if it is taken during the procedure, please confirm, I will then speak to my doctor about this. 

This is a patient with a complex problem, whose IVF doctor has not been transparent and open with her.  Anyone who says the embryos were Grade A , without specifying the number of cells in the embryo and giving embryo photos , is not being completely honest. Of course, part of the problem was she didn't know what questions to ask, as a result of which her doctor did not bother to share the basic details with her.

If she had done her homework before starting her IVF cycle, she would have learned that the only tangible product an IVF clinic can deliver is embryos , and all good clinics provide embryo photos proactively and routinely to all their patients, to document they have delivered high quality medical care.

Sadly, she has learned the hard way that she can't leave everything upto the doctor either - and she needs to be a well-informed patient, if she wants to get the best medical care !

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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