Sunday, October 18, 2009

Helping patients make sense of IVF

I just received this heartbreaking email from a distraught patient.

Sent: Sunday, October 18, 2009 4:51 PM
To: [email protected]
Subject: IVF

Sir .i show your mail sir. my IVF failure 3 eggs removeing .then 2 embryo put insaid i dont no dr.which tiyph eggs .i have no any pappers .he is toll me all o.k 2 week take rest ofter come check blood like that i take rest .ofter i go blood test he is telling negative .i cont i sak what hapen dr. dr say your oven insaid problam try again .becouse of i have no tube 3 times befor come tube pregnancy like that my both tube remove befor now my age 35. my blood test all o.k not any other problam but this come negative my money is all going this i will doit Bahrain country .please sir tel me your i dea nest too maths ofter want imake again any problam com .becouse now my husbent not nice with me .who mistage this one what hapen like this come please sent me replay i want go one more .

It is obvious that English is not her first language and she has been very brave in framing this email and reaching out for help.

So what makes this email so tragic ? Let me re-write her email in English - and then try answering her questions.

Dear Sir, I would like you to see my email. I have just had an IVF failure. The doctor removed 3 eggs and transferred 2 embryos. I don't know what type of eggs. I don't have any papers. My doctor told me everything was OK. He advised me to take rest for 2 weeks and come for a blood test. I did that but the test was negative. I don't know what happened. The doctor said you have a problem inside, which is why the cycle failed. He suggested I try again. I have no tubes because both my tubes have been removed because of earlier tubal pregnancies. I am now 35. My blood tests are fine and I don't have any other problem. All my money has gone into his treatment. I did this in Bahrain. Please tell me what your advise is. What should I do next ? Will there by any problem if I try again ? My husband is not nice with me anymore. What mistake happened this time ? Please send me a reply - I want to try once more.

It's hard to provide her with an intelligent explanation because there is no medical documentation of her past cycle. However, this email highlights that IVF patients feel abandoned after a failed cycle. They are often left high and dry , without even the courtesy of an explanation.

Doctors often underestimate the patient's ability to understand medical treatment. The treatment may be technically complex, but just because they cannot read or write well does not mean they don't have brains which can understand - or hearts which can break !

For all practical purposes, she will have to change her clinic and start all over again with a new ( and hopefully better ) doctor. The tragedy is that details of the failed IVF cycle could have provided the new doctor with useful information which he could have used to modify the treatment protocol for the next attempt. This information is now simply not available, so the patient is now back to Square One.

However, this bad experience will hopefully make her a more careful patient the next time around - one who asks questions and gets answers !

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