Thursday, March 03, 2011

What is the minimum number of follicles you need to proceed with the IVF cycle

We deal with a number of difficult patients who have failed multiple IVF cycles elsewhere. Many of these are poor ovarian responders and a common question is - How many follicles do you need to go ahead with the treatment ? Is there a number in your clinic below which you will cancel the cycle ?

These patients suffer from a lot of anxiety and apprehension during the superovulation, because they know they are not likely to grow many eggs. They have already had many of their cycles cancelled in the past - and this can be quite a cruel thing to do , because these are eggs which they have produced with a lot of effort ! Their eggs are precious - and represent their best chance of their having a baby with their own genes. This is why when the doctor cancels the cycle because they have not produced enough eggs, their heart breaks.

From the doctor's point of view, cancelling the cycle seems to be a very rational thing to do . Why make the patient spend so much money when the chances of success are so slim ?

What they forget is that the patient knew prior to starting the cycle that the chances of success were slim, so that the fact that she has grown few eggs has not really changed anything. If she's prepared to take that slim chance it can be cruel to deprive her of it

It's especially cruel when the real reason doctors cancel the cycle is because of "clinic policy" - because they do not want to mess up their success rate statistics !

These are challenging patients, and during superovulation, the major worry is - Will we reach the stage of egg colleection ?

Many doctors will cancel cycles if there are less than 4 follicles, because poor responders have a lower success rate and they do not want to harm their clinic IVF succcess rate. These are league table games clinics play, where they weed out the difficult patients to artificially elevate their published succcess rate figures.

We need just one follicle to go ahead, as long as the patient has realistic expectations and understands that there are still many more hurdles to be crossed after egg collection: there may be no egg; or the egg maybe immature; or it may not fertilise. We can be aggressive and are happy to do our best to help the patient to have a baby, but sometimes biology can be cruel !

With this approach , our patients have peace of mind they did their best ; that they explored all possible medical options and did not leave any stone unturned. With this approach, it's often easier for them to move on to Plan B ( adoption or donor eggs) because they know they've given it their best shot.

The outcome is always uncertain, and I do not want them to regret the fact that they did not try. We do our best to work with our patients - even if this brings down our success rates.

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