Friday, August 02, 2013

Is your IVF Doctor taking you for a ride ?

Every IVF patient knows that finding the right doctor can spell the difference between success and failure in their IVF treatment. This is why they spend a lot of time and energy in trying to find the right doctor . Part of the problem is that patients are not sophisticated enough to be able to differentiate between good doctors and bad doctors . They will often select a doctor based on his word-of-mouth reputation ; or because a friend tells them that they got pregnant after taking IVF treatment with that doctor; or after reading a newspaper article or full page advertisement about the doctor. They conclude that the doctor must be good – and often it’s the brand name of the doctor which sways them.  Many feel that because the clinic provides a five-star hospital setting , the doctor must be technically competent.

While these are useful markers , the fact remains that none of them is a reliable way of determining whether your doctor is good or not. Sadly, there are still lots of IVF clinics which take their patients for a ride . Even in a city like Mumbai, which has over 100 IVF clinics, only 20 have been registered with the ICMR so far !

Why are some IVF doctors bad ?  A lot of doctors don't have enough experience and expertise in doing IVF . They do it simply to augment their income . Others want to provide this as an additional service for their patients , because they do not want to lose the income which they would if they referred the the patient to a better IVF clinic. Some of them want to show to the rest of the world that they are as good as anyone else , and will often use their patients as guinea pigs , in order to learn these advanced techniques . IVF has a steep learning curve, and if you happen to have the misfortune to be one of the first  patients on which your doctor is honing his skills, you are likely to have a poor success rate . Just attending a 7 day course does not make a gynecologist an IVF expert !

How do you make out if your doctor is good ? This problem is likely to become even worse, as a lot of clinics are trying to corporatize themselves and start clinics all over the country by establishing franchises. What this means is that the doctor provides his brand-name to other doctors who want to start an IVF clinic in their own city.  This seems like a very attractive proposition to the local gynecologist, because he feels that he can then purchase  the technology , along with the brand-name .

Sadly, many IVF patients also get fooled by this . They feel that if they can get high quality treatment in their own city, without having to travel all the way to Mumbai , then isn’t this much better for me ? It’s much less of a hassle – and I can save money as well !

What they don't realize is that they're inadvertently signing up as guinea pigs , because even if the doctor buy the equipment, this does not mean that he has the required expertise ! Just because a doctor flies in from Mumbai or Delhi or Australia or UK once a month does not mean that these clinics can provide a quality of service which is comparable to IVF clinics which have full-time staff members which provide only IVF treatment, and nothing else.

What are some of the red flags which should warn you that your quality of care may not be very good ?
If the clinic has to depend on expertise which needs to be imported from somewhere else ( either a traveling embryologist or a visiting doctor), then this can affect your IVF success rates. This is because the care which they provide is episodic , and it becomes very hard for these clinics to provide high quality care because of the lack of coordination. They are not able to track their success rates or document exactly what they are doing . It’s very hard to remote control what's happening in a clinic when you're 500 miles away - and especially when the outcome is bad, there's often a lot of “ passing the buck “ between the expert doctor who is sitting hundreds of miles away in Mumbai , and the local IVF doctor .

Also, if the clinic does not provide you with photos of your embryos, this means there is a high probability that the clinic is not very robust , and is not very confident about the results which they can deliver. It's important that you do your homework , so that you can find the right clinic to maximize your chances of success. A very simple exercise is  to get a second opinion from another clinic , because this can give you a much better idea of what the differences and similarities between the two clinics are , so that you can make a well-informed choice. You need to do your own research – and thanks to the internet, it’s become much easier to do so !

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