Monday, April 25, 2005

When bad things happen to good patients

As a doctor, I try to do my best. I am an IVF specialist, and I would like all my patients to get pregnant in their first treatment cycle. Unfortunately, they don't, and this is a fact of life all IVF specialists have to learn to cope with. I recently had a young patient with unexplained infertility for whom we did an IVF cycle. She was an IVF specialist's dream - young; good ovarian response and excellent sperm. We collected 16 eggs, and confidently assured her that her chances of conceiving were excellent. However, when I did a "fertilisation check" the next day, I found that the sperm had managed to fertilsie only one egg of the 16 ! She had "total fertilisation failure" - an outcome which is every IVF specialist's nightmare because it is so unexpected - and so unpredictable. This meant that she had no embryos to transfer and was heart-broken - all that time, money and energy gone down the drain. While I know that we can get her pregnant the next time around by doing ICSI ( intracytoplasmic sperm injection) , where we inject a single sperm into the egg to make sure it fertilises, it's still hard to cope with the disppointment. I know you cannot count your chickens until they hatch, ( in IVF terms, I guess this means you cannot count your eggs until they become embryos ) , but there really was no reason for her eggs not to fertilise !
At such times, doctors always play the "what if" game. What if I had done ICSI in the first place ? However, this wouldn't have been correct either, because this would mean doing ICSI for all patients, and not doing IVF for anyone because of the risk of total fertilisation failure. In retrospect, on careful scientific analysis, we did to theright thing for her - and she happened to be one of the 5% of patients who fall into the category of " unexpected total fertilisation failure" which has been described in the medical literature - something which I could not influence. This is not the first patient this has happened to - and this will not be the last. I need to get over my grief and move on - and help her to do so as well !

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  3. Anonymous7:38 PM

    I was very interested to read your blogg because I have just suffered a failed IVF attempt where none of my eggs were fertilised even though I produced 11 mature eggs, my partner has healthy mobile sperm and we have achieved pregnancy naturally twice before. I was prepared for implantation failure or abnormal embryos but not complete fertilisation failure. My instinctive reaction is that the hospital made a mistake somewhere down the line. I suppose I'll never know.

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