Sunday, July 11, 2010

What tests should I do after a failed IVF cycle ?

There's lots of pressure on IVF doctors when an IVF cycle fails. Patients want a baby - and since they have not succeeded, they want answers as to why the cycle failed !

Doctors will take one of 3 approaches.

Many are nihilistic. They know that the tests we have today do not help much. Our technology is still fairly crude, because the commonest cause of failed implantation is genetically abnormal embryos, and we still cannot detect or prevent these, given the fact that human reproduction is a very inefficient enterprise. The best option for most patients is to just try again, and this is what they will advise.

Unfortunately, this straight-forward forthright approach is very difficult for most patients to accept . They want answers to their questions !

Unfortunately, the truth is that our technology is still not good enough to provide these answers.
After all, how can you track the fate of a microscopic ball of calls after they have been placed in the uterus ?

Some doctors are very aggressive. They will run lots of tests and often have pre-printed " panels of tests" for testing for everything under the sun - whether it's relevant or not ! Many of these tests are very expensive and can only be done in selected laboratories, which the doctor has a " special tie-up " with ! Most of these results are just lots of gobbledygook , and it's not possible to to make any sense of the results, because they have never been validated ! However, many patients are very happy with this approach. They feel the doctor has been " very thorough" - and now that a problem has been found, it can then be " fixed" , so they now have a better chance of having a successful IVF ( even though this is just a delusion !)

Some doctors are conservative. They will perform tests selectively, as needed, based on a careful analysis of the IVF cycle, and explain why these tests are needed; and what information they can provide, which can be used to modify the treatment plan for the next cycle.

Until patients learn to ask the right questions, they are unlikely to get the right answers !

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