Saturday, February 27, 2010

I am sorry - your HCG level is negative

These are the words every IVF doctor dreads having to tell their patient - and which every patient fears having to hear. There is so much hope, energy,time and money invested in an IVF cycle that when it fails, patients go to pieces. No matter how well you may have prepared yourself intellectually for the fact that not every IVF cycle succeeds, the news that this one has failed is still a major emotional blow, and it takes time to recover. The failure is often taken as a personal failure - and often reinforces the feelings of low self-esteem and inferiority which many infertile women suffer from.

" I cannot get pregnant in my bedroom - and couldn't even get pregnant after IVF. My body is flawed and useless. I let everyone down - my husband, my doctor and my family. I am a failure. I'll never ever become a mother ! What did I do wrong ? "

The first question often is - Is the test result reliable ? Maybe the lab goofed and mixed up my sample ? Coming to terms with the reality of failure is very difficult ! However heart wrenching this maybe, it's best to accept the truth, so you can deal with is. After all, every problem has a solution.

For many patients, the biggest problem is - How do I break the news to my partner ? This can be very difficult and it's very painful to watch your loved one break down. It's hard to provide a shoulder to cry on when you are breaking on the inside as well !

Some common questions are:

What happened to my embryos ?

When the embryo fails to implant, the cells in the embryo die because they no longer get any nourishment. These dead cells are then reabsorbed in the body. This is a silent process, with no symptoms or signs. We cannot determine why the embryos did not implant as we do not have the tools to monitor this intricate and complex biological process.

But I still haven't got my periods ? Doesn't this mean I am pregnant ?

The reason the period is often delayed is because of the luteal phse support provided by the estrogens and progesterone the doctor prescribes. The period will start once the meds are stopped.

Did I do something wrong which cause my IVF cycle to fail ?

No. This is a biological process which we cannot monitor or control

Did the doctor do something wrong ?

No. Most IVF cycles fail, and this is the sad reality we need to deal with today. The technology is not perfect.

Will I need a D&C ?

No, a failed IVF cycle is not a miscarriage. The embryos are microscopic and the utrine lining will shed on its own once the luteal phase support is stopped.

There's always a lot of recrimination and soul-searching , but most of this is misplaced. Most IVF cycles fail not because of anything you did or did not do, but because human reproduction has always been inefficient right since it first evolved.

You need to let yourself grieve - but you also need to learn to look forward ! What did we learn from this cycle ? What went right ? What went wrong ? Do we need to do anything differently the next time ? The failure of one IVF cycle is not the end of the world - and you need to bounce back and move on to Plan B !

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