Friday, September 17, 2010

Treatment independent pregnancies

Many IVF specialists have seen couples who do not get pregnant in the IVF cycle and then promptly conceive in the next month ! Even couples whom we think have no business getting pregnant do so all the time ( for example, those with very low sperm counts or poor ovarian reserve ) !

This is why IVF specialists no longer use the word sterility. We prefer the description, infertility, because this emphasises the fact that fertility is a relative term !

So are all these pregnancies miracles ? Not really ! When some patients fail an IVF cycle, they just give up. They believe - " If the IVF cycle failed, this means I am never going to get pregnant on my own , so why bother ? "

Others take a completely different approach. " If Dr Malpani can make embryos for me in his lab, I can do so for myself in my own bedroom ! " They become even more determined to have a baby on their own ! This phenomenon is well documented and these are called treatment independent pregnancies.

Why do they occur ?

I think there are many reasons for this. Even if the IVF cycle fails, we can explain to patients what we have learnt from the IVF cycle. Going through an IVF cycle makes patients much more aware of their body's signals and their fertile time, so they are better able to optimise their chances of having a baby !

For many, the IVF failure pushes them to put baby making high on their priority list and they spend much more time and energy on this , than they did in the past. They focus on improving their nutrition; body weight; overall health; and stop smoking. In some ways, the IVF cycle acts like a wake up call which spurs them into action !

Sometimes, there is also a spillover effect of the drugs used for superovulation in the previous cycle. These may have a residual effect, which helps boost ovulation in the next cycle ( though this has never been documented).

Also, when the IVF cycle fails, many patients turn to alternative medicine for assistance. They do yoga and acupuncture, and these may help them improve their fertility. A good example of this kind of success story is the heartwarming first person story, Inconceivable ( a book I tell all my patients to read !)

The truth is that doctors don't have all the answers ! Often we do not know or understand why these pregnancies occur ( even though we are quite happy to take the credit for them !) These pregnancies are a fact of life - we should study these, and try to increase the probability of their occurring ! This is the kind of study which is best done by patients themselves ( no pharmaceutical company will be willing to fund this kind of research !)

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