Sunday, April 25, 2010

Why did my IVF cycle fail ?

This is one of the hardest questions IVF doctors need to answer - and many do a bad job of dealing with patients when their IVF cycle fails .

When the IVF cycle fails , patients are understandably upset ! All their time and money has gone down the drain and they are now back to square one ! What went wrong ? Was the medical treatment of high quality ? Or did the doctor goof up ?

Doctors are often on the defensive when the IVF cycle fails. This is because many of them overpromise success in order to attract patients. They provide false hopes to lure patients into doing IVF. When the cycle fails, they often refuse to talk to their patients, partly because they feel ashamed that they have not been able to help them achieve their goal.

This attitude ends up creating even more resentment ! Patients feel abandoned . They perceive that IVF doctors are just out to make money - and that while they talk very sweetly before the treatment, once the cycle fails they refuse to even have the courtesy to provide a followup appointment or answer some basic questions ! What's even worse is that some doctors flatly refuse to give patients a copy of their medical records or even a basic medical treatment summary . Because they want to hold on to their patient, they hold on to all the medical records well - and this often smacks of a shady cover-up job. This is illegal as well - patients have a legal right to their medical records, and no doctor can refuse to give you a copy !

This is sad, because good IVF doctors do not have anything to hide. The honest truth is that there are no often no clear answers as to why an IVF cycle fails, because our technology is not good enough to figure out why embryos do not implant .

A good doctor understands the importance of sitting down with the patient and analysing the failed IVF cycle. At the end of each failed cycle, I explain

* what went right ;
* what went wrong;
* what we still cannot understand; and
* what we can do differently the next time to maximise the chances of success.

Most importantly, good IVF doctors need to prepare patients for possible failure even before the treatment cycle starts ! Patients are intelligent and need to taught to have realistic expectations before they start their treatment.

So if the cycle fails, does that mean we are really back to square one ? Not really ! We learn lots of useful stuff from each failed cycle.

Did the follicles grow well ? What was the egg quality ? Was the fertilisation rate good ?
Did the endometrium grow well ? ?
Was the transfer easy ?

Often the next cycle has a higher success rate, because we can customise and modify the treatment plan, based on what we have learned from the patient's response in the first cycle.

So if your cycle fails, try to get as much information from this failure ( and getting a medical treatment summary including photos of your embryos is critically important !) ; give yourself time to grieve ; and then move on !

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