Friday, September 18, 2009

Doctor, why did my earlier IVF cycle fail ?

As a senior IVF specialist, I see many patients who have failed IVF cycles in other clinics. One of the first questions they ask is - Why did my earlier cycle fail ? Why did the embryos fail to implant ?

In order to answer this question, I first need to review their medical records, to find out what was done in the IVF treatment. Unfortunately, most IVF clinics are terrible about documenting their treatment. Many clinics simply refuse to handover the medical record to the patient, claiming that it is their property. Others just provide a bare summary ( for example, " Embryo Transfer done" ), without even bothering to specify how many embryos were transferred or what their quality was !

( This is true of IVF clinics in India. US clinics are quite meticulous with their documentation , and doctors in the US are very careful about keeping records ( there are some medical benefits to living in a litigious society !) However, many US clinics still make patients work extremely hard in order to retrieve a copy of their records !)

Without this medical documentation, it's very hard to analyse the reason for the failure.
Broadly speaking , there are two possibilities

1. Biological problems with the patient ( for example, poor quality eggs because of poor ovarian reserve)
2. Problems with a poor quality clinic ( old malfunctioning laboratory equipment , causing fragmented embryos).

If the problem is because of a poor quality clinic, then this is easy to fix, by providing good quality treatment in a good clinic. However, if the problem is poor egg quality ( for example, in older women), then no matter how good the clinic, the success rates will be low.

I always remind patients that while the outcome of any treatment is uncertain, taking treatment at a world-class clinic will give you peace of mind you did your best !

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