Sunday, July 15, 2018

What are my chances of getting pregnant with IVF ?


The commonest question which a patient asks their IVF doctor is, "What are my chances of getting pregnant?" Now this is a deceptively simple question , but the answer can be surprisingly complicated, which is why most doctors will take one of two approaches to answer this.
Most will provide a highly inflated figure , because their only purpose is to make sure that the patient comes to them for treatment. So they'll say state some outrageous figure like 70% per cycle — an arbitrary number they pull out of their hat—and they have no way of being able to prove that this is the right number. Unfortunately , patients are not sophisticated enough to ask them to verify this figure, and because most Indian patients still have blind trust in their doctor , they will assume that this number is correct. Being na├»ve and gullible doesn't help , but patients are emotionally vulnerable, and doctors take advantage of this.
The better method is to provide a more tailored figure , based on the patient's age, her medical diagnosis and ovarian reserve—all the various biological factors which affect her chances of success. The problem here is that doctors can't be fortune-tellers , and it's impossible to predict for the individual patient what her chances are going to be.
The truth is that we are able to answer this question much more accurately after doing the IVF cycle,  because this gives us a chance to assess the quality and the quality of her embryos. However, patients doesn't want to wait till after the cycle—they want an answer right now ! This is why we sit and explain to patients that the number we provide as regards her chances of getting pregnant is just an estimate , based on : her medical history ; whether she has been pregnant in the past; the outcome of her earlier IVF cycles; her age (as you get older the chances decline , because egg quality declines) ; and her ovarian reserve, as assessed by measuring her AMH level and her antral follicle count. The problem is that are all rough estimates – after all, the final proof of the pudding is in the eating, and for an individual patient in a single IVF cycle, the success rate is either 100% or 0% !.
A better way of answering the question is to say, "In our experience, for patients like you , in your age group , with similar AMH levels and antral follicle counts, the pregnancy rate in our clinic has been  X % in the past. However, we will be able to answer this question more precisely once we've done your cycle for you, as we will be able to assess your biological response more accurately."
Thus, patients need to understand that there's a difference between ovarian reserve and ovarian response. Reserve is just a static number, measured by testing antral follicle counts and AMH levels – and we don’t treat numbers – we treat patients ! We are  much more interested in the ovarian response, which is dynamic – how well does the patient respond to the IVF superovulation, and how good are her embryos ?
The problem with a dynamic result is we cannot predict it in advance, because the body is so complicated , and it is affected by many biological variables, not all which can be measured. The truth is that every patient is different, and when the doctor is being honest, it may appear that he is trying to hedge his bets, or is not being forthright.
However, a good doctor is trying to be as truthful as possible, based on his clinical assessment, so that you have realistic expectations of what IVF treatment can offer you ! Biological systems are complex and unpredictable, and patients need to learn to come to terms with this uncertainty.
This is why it's so important that you find an IVF doctor you can trust , so you have peace of mind you have done your best ! 
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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