Saturday, February 13, 2010

Common mistakes IVF doctors make

I often see patients who have done IVF treatment at other clinics and sometimes I cringe when I see how poor the quality of the care provided was.

Here's a list of the common mistakes IVF doctors make.

1. Inadequate counselling. This is a very common problem. Because doctors seem to be so anxious to "grab" the patient and start an IVF treatment cycle ( before she runs off to some other clinic), many will advise a series of tests and commence treatment straight away. Most IVF clinics take pride in how many IVF treatment cycles they perform - irrespective of whether the couple needs it or not - and they want to maximise this number to maximise their income. This seems to give them bragging rights - see how many cycles I do and how much money I earn ! From a patient's point of view as well , the busier the clinic , the better it must be ! ( Actually, this is not true. There is an optimal number for every clinic, which is a function of how many doctors and embryologists they have on staff). Each patient is a potential source of income - and even if an alternative treatment might be a better option, they rarely bother to discuss these. Also, there is often no plan of action , and treatment is provided on an ad hoc basis, which means patients often don't know what to expect - and what to do if the cycle fails !

2. Overpromising. This is very common. Even brand new clinics which have never been able to achieve a single IVF pregnancy will claim success rates of 40% per cycle. They can get away with these tall claims, because there's no way of being able to verify them - or disproving them !

3. Being unavailable. Some doctors are so busy ( doing a humongous number of IVF cycles or running around from clinic to clinic or even town to town, to maximise their income), that they are just not available to answer the patient's questions. In fact, many couples complain that the only time they saw "their doctor" was at the time of the consultation. After this, everything is done by assistants , nurses or technicians - the doctor is "too busy" to be able to see you, sorry !

4. No customisation of the treatment plan. Many doctors blindly use a "one size fits all" treatment protocol. They make no attempt to tailor this to the individual patient's clinical needs - which means many cycles are cancelled either because of the risk of hyperstimulation ( too much stimulation) ; or because of a poor ovarian response ( too little stimulation) . These clinics use a standard cookbook approach which works well for about 80% of patients - but is of little use to the challenging or difficult patient ( older patients; patients with poor ovarian reserve;PCOD patients; and those who have failed IVF cycles earlier).

5. No documentation. This is a huge problem. No effort is made to document either the treatment given, or the patient's response. There are no ultrasound scans of follicles grown; or photos of the embryos in the lab. While this maybe because of outdated technology in some clinics, in many it's simply that the clinic refuses to provide this documentation to the patient. Many clinics keep all the records themselves - and refuse to even provide copies to the poor patient , who is left completely in the dark !

6. Not enough expertise in treating the infertile man. This is a very common failing in many IVF clinics. Since most IVF clinics are run by gynecologists, many do not do a good job of treating male infertility. They often refer the man to a urologist, which means that the right hand often has no clue what the left hand is doing. To make matters worse, they are often not set up to provide surgical retrieval of fresh testicular or epididymal sperm - causing a dramatic drop in pregnancy rates.

7. Many IVF clinics are not full service. For example, many do not have either the technology or the expertise to be able to freeze and store supernumerary embryos. While they may claim to do so, many still have terrible survival rates after thawing the frozen embryos - information they often hide from the patient.

8. Using outdated technology. Many IVF clinics do not bother to upgrade their equipment or their skills, which means they are not able to offer the newest advances, such as vitrification for egg freezing; or blastocyst transfer. If a pointed question is asked, they claim to offer these - even when they are not able to do so , simply because they know they can get away with lying !

9. Depending upon an "outside" expert to do the IVF. Many IVF clinics depend upon the expertise of a traveling IVF specialist or a visiting IVF embryologist. This means that the treatment is provided only in batches - and if you have the temerity to grow eggs too slowly or too quickly, your treatment will suffer, because the egg pickup has to be timed for a single day only !

If you feel your doctor is making any of these errors, you should look for a second opinion ! Don't take chances with your treatment - why should you suffer because of your doctor's mistakes ?

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