Monday, June 28, 2010

Doctor, what went wrong ?

Whenever an IVF cycle fails, the first question the patient demands an answer to is - Doctor, what went wrong ?

Some doctors get defensive when they hear this question. They feel the patient is challenging their clinical competence, and many will simply refuse to see the patient when the IVF cycle fails. This is adding insult to injury, because they have abandoned the patient in their time of need, simply because they do not feel comfortable answering uncomfortable questions. ( Many of this breed of doctor would rather spend their time doing consultations with new patients, so they can do more IVF cycles !)

Some will blame the patient - either subtly, or otherwise. " The embryos did not implant because you did not rest enough". Some doctors will use this as an opportunity to "run some more tests" to find out " why your body rejected the embryos".

Other doctors blame poor quality eggs and suggest donor eggs; and some will claim that the uterus was not receptive and advise surrogacy ! What often infuriates patients is the fact that none of these "problems" were discussed while the treatment was going on , which means the doctor seems to be "inventing" new problems after the cycle has failed. The same doctor who said "you have beautiful embryos" on the day of transfer is now saying - "your embryos were bad because of poor egg quality" !

In most cases, the truth is often much simpler. Just because the embryos did not implant does not mean anything went wrong - they just did not implant, that's all. The only "deliverable" an IVF clinic can provide are embryos - and once the clinic has made good quality embryos, there's very little anyone can do to determine their future fate after they are transferred into the uterus.

Human reproduction is not an efficient enterprise - and this is true whether you are having sex in your bedroom or whether you are doing an IVF cycle ! Just like couples do not expect to get pregnant every month they have sex ( even if they are completely normal and fertile), it's unrealistic to expect every perfect IVF cycle to result in a baby ! The trouble is that couples do not mind when it takes time in the bedroom - but when it takes time in the clinic , then this hurts !

It's important that doctors teach patients to have realistic expectations of the IVF treatment, before they start the cycle. Good doctors do this routinely - but bad once will often over- promise - and then under-deliver !
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