Tuesday, February 07, 2012

When should I stop trying IVF?

This was the plaintive question posed to me by a patient who had had failed four IVF cycles and had come to me for a second opinion. Should I do a fifth cycle doctor ? Shouldn’t I just forget about it ? Haven't I done enough already ? Haven’t I put myself through enough ? Haven’t I taken enough shots ? Changes enough doctors ? gone to enough clinics ? This is really getting too stressful - and I'm not sure whether it’s even worth trying again. Is it worth putting myself through all this stress and pain just to have a baby ? Is there any hope of IVF working if four cycles have failed ? What can you do differently ?

These are common questions IVF patients ask ; and the reality is we don't have any answers to them. Just because four cycles have failed , does that also mean the fifth cycle will fail? The chances of the fifth cycle working do not increase because of the four earlier failures – but neither do they decrease ! It's effectively a new lottery ticket - and the patient has to go through the decision-making process all over again . It’s a hard process and I don't think that I have the answers .

A lot really depends on the personality of the patient ! Typically , when we were kids , we were taught the importance of tenacity and persistence. We all know the story of King Bruce and the spider - and how we should keep on trying and trying again , until you finally succeed ! That logic is fine when you're studying for an exam or preparing for an interview - but does the same logic apply when you're doing something like IVF ? Unfortunately biological systems don't often follow logic , and it's important that everyone needs to draw their own “ laxman rekha” , their personal limit, so that they don't cross it before going to pieces or breaking down . Each person’s laxman rekha varies and depends upon many factors - emotional resilience ; personality; finances; temperament; social support mechanisms ; and how stable the marriage is .

You need to go through a lot of soul-searching before you make a decision , knowing full well that there is no easy answer no single right decision which applies to everyone - but that whatever decision you come to and find for yourself will be the right decision for you.

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