Taking IVF patients for a ride

I just got this email .

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My name is Mrs. AB. I am writing this mail on behalf of my elder sister - Mrs. DP who is undergoing IVF treatment. Kindly guide me whether she can continue with her IVF treatment further and what would be her success chances based on the latest IVF cycle details which she has undertaken recently. The details are as mentioned below:-

Her LMP was on 27th Oct 2009. Pick - up date was 7th Nov 2009.
1st Beta HCG was done on 17th Nov 2009. The value was 22.
2nd Beta HCG was done on 21st Nov 2009. The value was 10.
3rd Beta HCG was done on 26th Nov 2009. The value was 12.
Injection Beta HCG was given on 26th Nov 2009 night.
4th Beta HCG was given on 30th Nov 2009. Value was 70.
5th Beta HCG was given on 2nd Dec 2009. Value was 12.

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I was surprised when I saw this. Why had the doctor done so many HCG tests for the poor patient ? The HCG level of 10mIU/ml on 21 Nov ( 14 days after the transfer) had confirmed that the cycle had failed and that the embryos had not implanted. Why did he make her do so many more tests ?

I guess doctors do not want to tell patients the bitter truth, so they keep them hanging onto false hopes by repeating the tests and calling them "positive". A HCG level of less than 10 mIU/ml is negative, and there's no point in repeating it again.
However, some doctors will choose to interpret anything more than 5 as a "positive" because the normal range in the printed report is 0-5.

Patients are willing to be deluded - and because they do not get their periods, they feel they must be pregnant. The reason for the delayed period is all the hormonal support ( estrogens and progesterone) which is provided after the embryos transfer, so that just missing a period means nothing whatsoever !

To add insult the injury, the doctor then gave her an HCG injection on 26 Nov to "support the pregnancy" ! Giving anyone a HCG injection ( even the husband !) will result in a positive blood test for beta HCG - and this a common technique which many doctors use to fool ignorant patients. Incidentally, this is why the first HCG level on 17 Nov was 22 ( it was more than 10, which means it was positive). It was a result of the HCG left in the body after the HCG trigger shot given prior to egg collection.

Patients need to be well-informed to ensure their doctor does not take them for a ride ! If the HCG level does not rise, this means you are not pregnant - period. There is unfortunately nothing anyone can do about this. You need to accept the bitter truth and move on.

However, unscrupulous doctors point to the "positive" HCG result and claim that the cycle succeeded ; and the fact that the levels dropped afterwards means the patient miscarried. If the patient gets hoodwinked, she is hooked onto doing another cycle with the same doctor - after all, if the cycle succeeded in getting her pregnant, this means the doctor is a good doctor, and she has a good chance at getting pregnant if she continues trying again. After all, the fact she had a miscarriage must mean she had done something wrong, so why blame the doctor for her failure !

Doctors can fool patients once. However, once patients find out the truth - as they will, sooner or later - this kind of jugglery will backfire !