Friday, August 25, 2006

When bad things happen to good people - dealing with a negative beta after IVF

Even though I have been doing IVF for the last 15 years, I still find it extremly difficult to tell a patient an IVF cycle has failed when her beta HCG results come back as negative. No matter how "perfect" the cycle, the outcome of an individual IVF cycle is always uncertain and uncontrollable. This is why a failure hurts - especially when the cycle goes the way it should and we have transferred beautiful embryos.
This is a difficult situation for both doctor and patient. I feel I have failed my patient and let her down by being unable to give her the pregnancy she so deeply desires. Doctors are human, too, and we also find it hard to deal with failure. Of course, I know in my heart of hearts that I have offered her the best possible medical treatment; and that medical technology has its own limitations - but it's still difficult to face failure. No matter what my brain says, the heart still hurts, because you do get attached to patients, and their drams become your dreams. Fortunately , the reason I don't burn out is that to balance the failures, I have the successes - couples whose lives have improved dramatically when they succeed after IVF. Every baby born gives me hope and faith that what I do is worthwhile !
For patients, on the other hand, a negative HCG is nearly as bad as dealing with the death of a loved one. In one sense, it is the death of a loved one - the death of the transferred embryos; and , even worse, the death of a dream.
Patients have many questions after a failed IVF cycle. Why did it fail ? What can we do differently the next time ? Often we don't have any answers because embryo implantation is a biological process we cannot control or monitor - and this makes matters even worse, because patients expect their doctors to have allthe answers. Not knowing causes fear and anxiety - "Will I ever get pregnant, now that even IVF has failed ? " What does the future hold for me ?
Patients often blame themselves when the IVF fails. Did I rest enough ? Is my uterus "bad" ? Why did my body " reject " the embryos ?
In addition to the factual questions, the failure opens old emotional wounds of low self-esteem. "I have let everyone down by failing the IVF cycle". " All that money gone down the drain".
We often need someone to blame when the cycle fails - and doctors are often the target of the anger ( and though this is often misplaced blame, I tell my patients to vent their anger on me, rather than on themselves ). I can handle the criticism, and I feel it's good for them to get it off their shoulders.
While many appreciate everything we have done for them, even when the cycle fails, a question which haunts most couples is - " Why me, God ? " Unfortunately, bad things do happen to good people - just like good things happen to bad people. It's hard to make sense of some of life's events. Mature people take the good with the bad - and carry on. "This too will pass" are the wisest words known to man - and we all have the resilience to deal with failure and move on.
Success after failure ( and just because one cycle has failed does not mean the chances of success in the next cycle go down) tastes even sweeter !


  1. Anonymous4:48 PM

    One thing that both Dr. and patient can keep in mind is..they are not in charge. That's why life is such a miracle, a gift, given by God.

  2. Anonymous12:42 AM

    Dr. Malpani!
    I am so grateful that I can read your words. At last somebody, who can understand what a woman can feel, when she can't get the one she desires the most for. The self-reproach, the feeling of being "bad-quality material", inability to change things, being envious to others, etc. I never would like anybody to experience all these horrible steps of self-recognition.
    You really seem wanting to help people very much! Thanks again.

  3. Anonymous12:41 AM

    Love you doctor! Nothingelse can explain my emotions better when I read this post.


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