Tuesday, August 18, 2009

What’s Plan B ?

Before starting an IVF cycle , I always ask my patients – What is Plan B ? While it is true that the success rates in our clinic are very high , it is also true that the chances of failure in one IVF cycle are higher than the chances of success.

While it’s easy to deal with success , one also equally needs to prepare for failure.
I tell patients to prepare a contingency plan, so that they are not shattered in case the IVF cycle fails. While most patients are realistic and understand the importance of having a backup plan in place , other take offense and feel I have an unnecessarily pessimistic attitude . The truth is that I am an optimist – but it is my job as a professional to present both sides of the coin. After all, the sad reality is that not all IVF cycles have a fairy-tale ending where everyone lives happily ever after !

I tell patients to prepare a list of options, so that intellectually they know what their possible courses of action are, in case the treatment fails. I feel doing so provides patients a certain degree of emotional stability, which helps them to cope better when confronted with the IVF emotional roller coaster ride . It's very hard for patients to think straight when they find out that their beta HCG result is negative and their embryos have failed to implant. This is the worst time to start asking – What do I do next ? If patient's are both mentally and rationally prepared for failure , they will find it much easier to accept this , in case the cycle fails.

Unfortunately, some patients get so paralysed by fear and anxiety when they think about the possibility of failure, that they just cannot start an IVF cycle. For these patients, just acknowledging the fact that the cycle can fail and preparing for this eventuality can help them to move ahead with their treatment. After all, what is the worst which can happen in an IVF cycle? Yes, the cycle may fail and you may not get pregnant. But you will be no worse off than before you started – and life does not end with the failure –there are still additional options which can be explored !

So what are the other possible options ? Often the best option is to repeat the cycle again. This is particularly true if the cycle was a textbook cycle , with good-quality embryos , a receptive endometrium , and an easy embryo transfer. If there were technical difficulties , these can be identified and then corrected in the next cycle. However , sometimes it's necessary to think of third party options, and this could include using donor eggs, donor sperm , donor embryos or surrogacy. Adoption is always an option which should be carefully evaluated; as is the decision to remain childfree. If you are not happy with the quality of medical care or emotional support you have received , your best option may be to change your IVF clinic.

I still find that many patients refuse the entertain the possibility of failure. They use denial as a protective mechanism, but this can be counterproductive and can actually backfire. Not having a Plan B is in one sense the worst plan , because this means they are not willing to accept reality. These patients need much more counseling and hand-holding, so that they can move on with their lives.

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