Friday, November 30, 2012

Why should every couple going in for IVF also consider adoption ?

I am an IVF specialist, and many infertile couples I see are worried, depressed and frustrated . They come to me because IVF is their last resort. All the other treatments they have tried have failed, and they are often at their wit’s end. IVF is the treatment which offers them their final chance of having a baby , which is why all their hopes ride on the outcome of the IVF cycle . When I do a consultation , I explain to them that while IVF is a treatment option which is well worth exploring , they should also consider adoption simultaneously.

A lot of patients get very upset when I bring up the topic of adoption . They feel that I am being negative and pessimistic ; and their secret fear is that since I am talking about adoption, I think their chances of success are very poor and their IVF cycle is likely to fail. Some get irritated because they feel that I should have enough sense to realize that if they wanted to adopt , they would not have come to me in the first place !



  1. Anonymous11:17 PM

    Is it not a paternalistic approach ? When patients come to you they must have thought a lot about their situation than you could imagine. Why should you then ask them questions which could hurt them and make them feel uncomfortable ? Is it even polite ? Don't they know better ?

  2. I don't think I am being paternalistic by telling patients to consider an option.

    Yes, patients are smart and will make up their own mind. However, sometimes they need to hear from their IVF specialist that adoption is a perfectly reasonable choice.

    I don't ask them questions to make them feel uncomfortable . I am proactively bringing up a potentially touchy topic and giving them permission to discuss this. I do this because I am trying to help them find the best path for themselves !

  3. Anonymous1:42 PM

    But then shouldn't you get their permission to talk about such a touchy subject (instead of giving them permission !) ? If you don't, then doesn't it mean you are forcing them to discuss something which might not be easier for them especially with an IVF doctor ?

  4. Why should it be hard to discuss any topic with your doctor ? Patients should feel comfortable discussing anything with a doctor !

  5. Anonymous8:32 PM

    Ofcourse many patients feel uncomfortable ! You yourself accept the fact that many patients feel offended. Then it means you are not doing a good job in asking such questions. What you say is not important but how you say is ofcourse important.You are dealing with humans who are more emotional than logical creatures. When a patient comes to you, without understanding anything what they have gone through; when you raise such question within 10 minutes of consultation anyone will feel vulnerable.

    But I did appreciate the logic in what you say. It does give lots of emotional protection to patients if they act according to your suggestion. Perhaps you need a better way of conveying your thoughts.

  6. Can you guide me as to how I can do a better job ? Am always happy to learn from the true experts - patients !

  7. Anonymous4:58 PM

    When you ask patients coming to you for treatment, ‘why do you need a baby?’ – It sounds really harsh.

    Instead you can ask them, ‘How important is a baby in your life? Or Life without baby is hard – isn’t it?’

    When you put questions in this way, they feel better emotionally and will open up.

    If you ask your patients, ‘What will you do if this IVF cycle does not work? What are your next plans or plan B?’ - This kind of questions is sort of direct emotional attack! It appears as if you are distancing yourself from them and asking these questions to just study what is in their mind.

    Instead you can say ‘this is a process which has limited success rate; as of now it is hard to say whether you will succeed or not. In case if it fails it will be very hard emotionally. You might need an alternative plan to cope with the failure. Have you ever thought of an alternative?’ This is a very compassionate way of asking the patients and they will also feel comfortable to talk about it further.

    When the cycle doesn’t go as expected instead of saying them – I’m disappointed (it is very scary if the doctor himself says ‘I’m dissappointed’) ! try telling them that ‘ the cycle doesn’t look as good as I expect it to be, it could have been better. But people get pregnant in less than optimal looking cycles too’. In case if you intend to cancel the cycle, instead of telling them ‘we will cancel the cycle and let us see how it goes next time’ – try asking them what are their fears and what problems will they face if this cycle is cancelled. This will definitely make them understand that you care for their emotions.

    Instead of asking
    Where are the photos of your embryos?
    Why didn’t you get a copy of your medical records?

    The above questions have an accusatory tone and will instil guilt in the patients. You cay try telling them ‘ If I could get a chance to look at your embryo photos and your medical records from your previous IVF attempt it will be much easier for me to make appropriate decisions’.

    Every patient who comes to you faces so many problems in their life. There are people who sell their jewels and properties to pay for the IVF cycle. There are people who borrow money or take loan with an intention of fulfilling their baby dream. There will be women who are made to believe that a baby is the only solution to all their troubles. There are people who face social and financial problems because of infertility. Not everybody will be gifted with good reasoning power. Logical, brutal questions (you say it as honesty!) will hurt their heart before it could reach their brain. When there is emotional pain the brain loses its power to think. They will feel ridiculed.

    Ofcourse your intention is very good and you can ask brutally honest questions and give honest feedback provided you make initial efforts to gain their trust. They should understand that you are not ridiculing them. This cannot happen in 10 minutes!

    But you know better, don’t you ?

  8. Thanks - this is very good advise, and I will do my best to implement it. However, I am a human being, and it can be hard to unlearn some bad habits !

  9. Anonymous7:08 PM

    True, patients are human beings too ! It is very hard to unlearn bad habits for them too - so be patient with patients ! : )


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