Wednesday, October 07, 2009

Does your IVF clinic have a full time embryologist ?

Most patients are quite clueless when selecting an IVF clinic. Many of them will select a clinic because it happens to be close to where they live; or because they know someone who got pregnant after taking treatment there; or because they read a newspaper article which shows a proud 65 year old mother posing with a baby

However , this is bot a good way of choosing a clinic. IVF requires a lot of experience, expertise , teamwork and technology - and you should select a clinic based on the technical competence or expertise of the doctors. One convenient way of doing this is to choose a clinic based on its "success rates". However, it's very easy to game these, so these are not always reliable either !

Here are some basic criteria which every good IVF clinic must meet. They may seem very obvious , but you'll be surprised by how many clinics do not meet even these basic norms !

1. Full time IVF doctor, who does only IVF. IVF is a demanding procedure which requires the full-time attention of the doctor. Doctors who do this on a "part-time" basis ( while delivering babies and doing hysterectomies) are not always the best choice.

2. Full time IVF embryologist . The IVF lab is the heart of the IVF clinic - and it's the embryologist who makes sure the lab is running optimally. Unfortunately, because there is an acute shortage of embryologists in India, most IVF clinics do not have their own embryologist. This means they have to depend upon external experts who fly down for 2-3 days. While these experts are skilled, the problem us that because they are in the lab for such a short time, the patients need to be "batched" together. While this works well for most patients, not all patients eggs will grow by the book. Thus, while this may be fine for young patients, it;s not a good idea for older women; patients with PCOD ( because of the risk of OHSS); or patients who have failed IVF cycles in the past. These patients need much more individualised care and personalised protocols for superovulation, to maximise their chances of success.

What often ends up happening is that older women or those with poor ovarian reserve often do not grow eggs and are pushed into accepting donor eggs or donor embryos. Many do say yes out of desperation - whereas the fact is that they could have achieved a pregnancy in a better clinic with their own eggs.

Also,this kind of batching does compromise the quality of care. Since these experts come from out of town, they cannot spend too much time in the clinic. They remain for only 2-3 days, which means they can only do Day 2 transfers. The embryologist is so busy doing IVF and ICSI that he does not have time to freeze the supernumerary embryos; which means that if the cycle fails, patients are forced to start a fresh cycle all over again.

Also, because there are so many patients to be treated in 2-3 days, everyone is in a mad rush , which markedly increases the risk for errors. Finally, because the IVF is done by an "outside expert", there is no opportunity for interaction between the IVF doctor and the patient.

While this kind of IVF is a reasonable stop-gap solution for under-served areas, it's not in your best interests; and if you can afford it, you should always travel to a clinic which does IVF all the time, so that the treatment is adapted to suit your cycle, and not the other way around !
Work all the time

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