Monday, December 04, 2006

We treat patients, not numbers !

As an IVF specialist, I often receive queries from older women who have a high FSH level. A high FSH level suggests poor ovarian reserve which means that these patients have a lower chance of getting pregnant. Few eggs = few embryos, of poor quality = low chances of success.

Some patients are willing to accept this harsh reality; and will then consider alternative options for building their family, such as egg donation ( which has a much higher success rate); or adoption.

However, others are quite sure that they want to try at least once with their own eggs. They often ask us - " Is there a FSH level beyond which you will not treat " ?

Many clinics in the US do use a "cutoff level". This is often 12 mIU/ml, and they will not treat patients with a FSH level higher than 12. One reason is because the chances of a pregnancy are poor . The other reason is that they do not want to impair their published success rates ( as this will affect their rankings in the "IVF success rate league tables") and reduce their ability to attract new patients.

I think this is unfair. As long as patients have realistic expectations of the treatment, doctors should allow them to make their own decisions. While they may end up spending a lot of money and still fail to achieve a pregnancy, at least they achieve peace of mind and emotional closure they did their best. Also, even if the attempt fails, they find it easier to move on with their lives and consider alternative options because they gave it their best shot. Since IVF cycles do not carry any medical risk , I feel this is reasonable.

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