Thursday, May 08, 2014

How IVF doctors fool patients

Patients do IVF treatment with a lot of expectations . IVF treatment is extremely expensive , but they know that this is the one option which maximizes their chances of getting pregnant .  However, when patients are not well informed , it's very easy for unscrupulous IVF doctors to fool them.

Infertile patients are emotionally vulnerable and willing to clutch at straws because of their desperation. There are many ways in which bad IVF doctors cheat IVF patients.

For example, some will charge for doing a procedure in the lab ( for example, laser assisted hatching), but will actually not perform this. Documentation is very poor, and  most patients are pretty clueless as to the technical details of an IVF treatment, so it’s easy to take them for a ride. ( I know of clinics which routinely charge for laser assisted hatching, even though their laser has stopped working for the last 6 months !)

Many clinics paint a rosy picture to attract patients. At the time of the first consultation, the “brand name doctor” is very sweet and obliging. When they are trying to “sell” their services to the patient, they inflate their success rates,  and talk about pregnancy rates of “ between 40% to 50% “ . They have no actual proof of this – and without independent auditing, it’s very easy to manipulate statistics by cherry picking patients and selecting a convenient numerator and denominator.

A lot of IVF clinics are often unscrupulous about the advise they offer to their patients . Thus, when an IVF cycle fails ( sometimes because of poor IVF lab conditions), the doctor will “blame” poor quality eggs for the failure, and advise that the patient use donor eggs to improve her chances of success.

Often, they overpromise success at the time of the embryo transfer, by saying that the embryos are perfect Grade A embryos ( without ever providing a photo for actual documentation). Then when the cycle fails, they tell the patient that her uterus is “rejecting” the embryo and that she needs surrogacy to “treat” her implantation failure. Some even blame the patient for the failure, by saying that she did not rest properly, which is why her embryos “fell out” of her uterus.

When one cycle fails, often the reason for the failure may just be a poor quality lab which created poor quality embryos. Rather than change eggs or the uterus, the patient would be much better off just finding a better IVF clinic !  However, doctors are understandably reluctant to refer their failures to better IVF clinics. They would much rather hang on to their patients ! They offer options which are designed to maximize their profit , and are not necessary in the patient's best interests .

Poor quality IVF clinics will often blame “ bad sperm “ for poor quality embryos. They will bamboozle the patient by talking about high sperm DNA fragmentation rates , or abnormal sperm morphology , and claim that this was the reason for the poor embryo quality. This is patently false, because when the same patient does ICSI at a better clinic ( with exactly the same sperm !) they make Grade A embryos !

Because patients are clueless, some of the “high-end” clinics take patients for a ride by doing expensive immune testing and running panels of genetic probes – all of  which just create lots of random noise and provide very little useful clinical information. However, patients are suitably impressed by computerized reports which are full of scientific gibberish.

Thus , women with a positive TB PCR test are “treated “ with antiTB treatment for months on end. Not only was this treatment completely uncalled for, it exposes them to a lot of toxic side effects – and wastes precious time .

When the embryos are poor quality, some doctors will tell the patient that we will transfer donor embryos into your uterus, so you don’t waste this cycle. By this time, patients are often fed up and frustrated. They fell helpless and powerless , and are happy to do whatever the doctor advises, because they so badly want to have a baby. They are happy to pay whatever extra fees the doctor charges, so that they can get pregnant, without thinking of the long-term implications of their decisions.

Bad doctors exploit their patient’s ignorance and vulnerability. Because the patient is desperate, they take advantage of this. They package their advise of using donor embryos as a technique to maximize the success rate, and patients are made to feel grateful for this. While this may work in the short term, these kind of decisions made on the spur of the moment under pressure may have long term adverse consequences for the patient. When doctors take eggs from patients and use them someone else without getting informed consent from either of the couples , they can improve their pregnancy rates – but will harm their long term reputation.

Patients are not stupid , and they exchange notes and talk to each other – and to the clinic staff as well. When they realize that the IVF doctor  resorted to these hanky-panky tricks, they get upset and angry.

IVF doctors need to get their act together . We owe this to our patients. We need to be honest and upfront with them , by providing better quality documentation and high quality counseling services .

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