Saturday, July 27, 2013

IVF processes and outcomes

When patients do an IVF cycle, the only thing really care about is the outcome – they just want a baby ! If life were perfect , then every time the patient had a perfect IVF cycle , she would get pregnant . Unfortunately, human reproduction is not an efficient enterprise , and the outcome of an IVF cycle is always uncertain. This is because biological processes cannot always be influenced by the doctor and we have very little control over what will happen to the embryo after we transfer it into the uterus. The sad reality is that we cannot manipulate the process of implantation This is not something which must patients want to hear . It's an uncomfortable feeling knowing that no matter what you do, you can never be sure what the result of the IVF cycle will be – each IVF cycle is effectively a gamble , which you may have to repeat multiple times , until you achieve success.

This is why it's important to differentiate between processes and outcomes . While outcomes cannot be controlled , the process itself can be, and a good IVF clinic will follow good processes. Now if life were always, fair good process would always lead to good outcomes, so that everyone's happy. Unfortunately, good processes can lead to bad outcomes , and an IVF cycle can fail because of circumstances which are beyond the doctor's control.

While mature patients understand this , most patients are not sophisticated enough to appreciate this, and if the IVF cycle fails , they are understandably upset and frustrated . They will often vent their anger on the doctor , complain about his clinic, and even write bad online reviews that he's incompetent and has not done a good job , even though the process he followed may have been perfect . Conversely, we do have bad IVF clinics , where patients do get pregnant, in spite of the fact that they follow bad processes . This is just plain dumb luck - and is particularly common in very busy clinics who will do lots of IVF cycles for young patients who don't even need IVF in the first place ! These clinics will obviously have a high success rate , as a result of which their reputation in the community will spread , because patients are not sophisticated enough to understand that the good outcome was not a result of good processes, but because of smart patient selection ! As a result, some of these doctors continue to fool some of the patients some of the time . Finally you have clinics which follow bad processes and therefore have bad outcomes. These will shut down in a few years – but only after having caused a lot of harm !

When a cycle fails, most patients cannot differentiate whether the bad outcome was because the doctor followed bad processes , or whether it was a result of plain bad luck, even though the processes were followed perfectly.  Unfortunately many IVF doctors are not transparent ; and few patients are willing to invest the time and energy in order to understand the process which were used. Consequently, many clinics get away with fooling their patients , by preying on their ignorance .

Just like it's important for a good doctor to follow good processes it's equally important for a patient to become a good patient and do their homework , so they understand the difference between good processed and bad processes, no matter what the outcome !

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