Thursday, December 22, 2011

IVF or IUI - should I let the patient decide ?

I just saw a 28 year old woman with unexplained infertility. I am a conservative doctor and suggested that the logical treatment option for her would be intrauterine insemination ( IUI).

However, she was quite adamant that she wanted to do IVF. She had done her homework and knew that IVF had a much better success rate than IUI. Since it did not involve surgery or have any medical risks, she was sure IVF would be better for her, because she did not want to waste time.

" Why should I do a treatment which has a success rate of only 10% when I can go in for a treatment which has a success rate of 46 % ? I am paying for this myself, and my time is at a premium. I have only one life, and want to enjoy being a mom when I am young and have lots of energy. Both IUI and IVF involve coming to the clinic 6-7 times each month, and I'd rather select an option which would have a higher yield. I am the kind of person who flies first class - and IVF would actually be more cost effective for me !"

This was a woman who knew her own mind, and it was hard to argue with her logic. Money was not an issue for her; and she was well-read and well-informed.

This is a good example of IVF being done for patient reasons, and not medical reasons. I believe we should respect patient autonomy , and allow the patient to decide.

Will this lead to overtreatment ? Yes, but there are lots of advantages to this approach.

It saves the patient valuable time , because she'd rather focus on bring up her baby and moving on with her life, rather than making multiple trips to the infertility clinic !

This approach is quite ethical, because it put patients in charge of their treatment ( respects their autonomy) ; provides them the benefit of a higher success rate ( beneficence) ; and also has no risks or downsides ( non-maleficence) .

Is it ethical for me to refuse her request ?
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  1. Good to read this.
    This is very similar to my case and I'm happy that you decided to go with the patient's requirement and opinion.
    Very few doctors like you let the patient decide for herself.

    1. All good patients should insist their doctors allow them to make the final decision.
      Doctors and patients are partners!

  2. Anonymous9:57 PM

    Dear Dr,

    I have to disagree with you. Being a patient who has no other option other than IVF and having done IVF 6 times with no baby in hand I know how uncertain IVF is. For a successful IVF and to obatin a baby in hand you need to be lucky. I agree I am not but can you assure that the 28 year old patient of yours will not be unlucky like me. For example if the lady who came to you does IVF and fails, then tries again and fails and suppose if she is not lucky the third time too, mentally she will be very disturbed. And if she reads in internet all the possible problems that might exist which can lead to the lack of success she will definitely start thinking that her body is defective. As you know IVF is the last resort of an infertile couple no one should jump into that last option so soon. This will keep them mentally sane and confident. If I am in your position I will explain her this and make her explore all these to her before jumping into IVF. Please let her not do IVF just because she has money and definitely IVF is not a short cut to obtain a baby. But I sincerely wish she gets success in her endevour soon.

  3. She doesn't have unrealistic expectations, and doing IVF will help her remain in control of her life. It reinforces she is in charge of making her own decisions, and by taking ownership of her decisions, she will have peace of mind she did her best


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