Tuesday, March 13, 2018

What can we do differently in the next IVF cycle ?

When an IVF cycle fails, this is the commonest question which patients ask - What can we do differently next  time ?
They naively believe that the fact that the cycle failed means something went "wrong", and if we identify and  " correct" this, the next cycle will succeed.

This is why doctors do lots of tests; and propose lots of new and more "advanced" treatments, in order to improve the chances of a pregnancy.

Here's a list of the tests which may be proposed , to allow the doctor to "investigate" the reason for the failed implantation in more details

ERA
TB PCR
hysteroscopy
Antibodies

The list of "treatments" to fix these problems is equally long

PGS
IVIG
Immune therapy

The problem is this is flawed thinking, based on unrealistic expectations . An embryo is not a baby, and we don't have the tools to be able to drill down and find out why an embryo did not implant.

Yes, we can provide generic reasons such as "poor endometrial receptivity", but these are "waste-paper basket " diagnoses. We can never prove disprove these labels, which is why they don't provide any useful actionable information.

If the doctor transferred top quality blastocysts into a 8 mm trilaminar endometrium, then all you need to do is to be patient and repeat the cycle until you get pregnant. Changing something just for the sake of doing something different is not a good idea.

The problem is that doctors are also prejudiced to doing something "new and different" - partly because they like playing with the newest toys, and partly because they can charge more for doing these .

Also, because some patients will get pregnant after these tests and treatments , both doctors and patients get fooled into thinking that it was the new treatment which resulted in the success. This is the classical "post hoc, ergo propter hoc" fallacy which seduces so many people. The reality is that lots of these patients would have got pregnant even if the doctor had done nothing new !

The rule is simple - caveat emptor ! Don't let the doctor use you like a guinea pig !

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