Wednesday, August 27, 2014

When not to do IVF

Most infertile patients know that IVF is the treatment option which maximizes their chances of getting pregnant .

However, the problem seems to be that the pendulum has swung in the other direction , and lots of patients are being advised to do IVF, even though they do not need it. The truth is that there are many simpler treatment options available to treat infertility, and not every infertile couple needs IVF !

Thus, young patients with PCOD can easily be treated with medicines for ovulation induction. This is much less expensive than doing IVF – and it’s much more fun making babies in the bedroom than going to an IVF clinic.

It’s important that patients explore these simpler treatment options before moving on to IVF , which can be expensive .

The other group of patients who should not be doing IVF are the ones for whom the chances of success are extremely low . For these, treatment may be futile. Examples would include patients with Asherman syndrome , where the uterus has been completely damaged ; or patients with ovarian failure, who will not be able to grow eggs, no matter what we do.

These can be difficult patients to tackle . They are extremely desperate to have a baby , and are not willing to consider third-party options, such as donor eggs or surrogacy . So what is the poor doctor supposed to do ?

A good doctor will counsel patients that their chances of success are extremely poor. After doing so, if the patient has realistic expectations and still insists on going ahead , I think it's fine to do so, since the patient has provided informed consent . However, the danger is that often doctors are not very forthright, and they will hide this critical information from the patient . Some will go ahead with IVF treatment and transfer embryos into a uterus which such a poor lining, that the embryos do not have even the slightest chance of implanting.

Some IVF clinics will even transfer embryos which have arrested in the lab into the uterus, and thus fool the patient that they have received IVF treatment ! Others will go ahead with the treatment cycle, and then tell the patient at the last minute that since your embryos are of very poor quality, we need to use donor embryos in order to achieve a pregnancy. Because patients are so desperate at that point , they will go ahead and do whatever their doctor tells them to do, but this often results in long term unhappiness for the couple, who wasn’t mentally prepared to use donor embryos, and they may reject the child.

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