Thursday, February 02, 2012

So what do I do next Doctor ?

I often see patients who are at a crossroads after having failed 3 IVF cycles . They are confused as to what to do next. Should I try another cycle ? should I use donor eggs ? should I use a surrogate ? should I change my doctor ? should I do a blastocyst transfer ? They have lots of questions - and they often not sure what the best option is !

By the time they have failed 3 IVF cycles , they’re pretty well read and well informed - but often more confused , because there are so many different doctors and different websites giving diametrically opposite information, so it’s very hard to make sense of it.

Do you trust the anecdotal story of your online bulletin board friend who conceived after taking intravenous immunoglobulin or do you trust your doctor who tells you intravenous immunoglobulins are expensive hocus-pocus and just a waste of money. How is a poor patient to decide?

While I cannot give a straightforward simple dried cut and dried formula for how to make the right decisions , there is a simple process which needs to be followed to make sure that you make the decision which is right for yourself. Do remember that there are no right answers which apply to everyone - there are only answers which are right for you - and you need to find these for yourself.

Step number one is to think logically . Use left ( intellectual) part of your brain , to make a matrix of all your options – the cost ; pros and cons , and so forth . Step number two is to use your right brain , so you can decide which among these options appeals the most to you . You need to order these - which is Plan A ? and which is Plan B ? Which would you prefer to do if you had all the money and time in the world ? and which is the last possible thing you’d want to do , but would do if you were forced to do it and didn’t have any other choice .

Finally , the third step is to work out the logistics after you’ve done the first two. The commonest mistake patients make when they're making treatment decision is that they first try to work on the logistics. How much will it cost ? Can I afford it ? Which doctor should I go to ? How many days leave should I take ? Will I be able to fit it in my work schedule ?

This is the wrong way of doing things , and because they start off in the reverse direction , they end up making a mess of the decision. Start with a clean slate - and imaging what you would do if you had no limitations ; all options ; and all possible resources under the sun. Then start thinking about what would I like to do first . That’s where a bit of brainstorming and creativity comes in . You then gradually start restricting yourself based on real life constraints, so you can come up with realistic options , which are workable for you . If you use a systematic approach , your ability to come to the decision which works best for you is extremely high , as compared to a haphazard procedure which seems to depend more on what articles you read or which friend you have spoken to last !

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