Monday, July 20, 2015

Is IVF useful for women who have repeated miscarriages ?

Women who have had repeated miscarriages are often very frustrated . Not only are they extremely upset and unhappy with themselves , because their body doesn't work properly , but they find it very hard to get reliable medical advice . Each doctors gives them a different opinion; and websites will often provide diametrically opposite and contradictory information . Patients are completely confused and lost , and don't know whom to believe , and what to do next . A lot of them get paralysed , and many just give up.

Recurrent pregnancy loss is a very confusing problem , and we do not have the tools and technology to be able to pinpoint what the problem is for the individual patient . While we do know in general that the commonest cause is a genetic problem in the embryo , this is often very difficult to prove or to establish for an individual patient. This is why we often resort to empirical therapy - treatment based on experience with other patients , rather than on running tests for that specific patient , in order to try to find a specific diagnosis, because this is often an expensive wild goose chase, which provides no useful information.

Patients are extremely unhappy when we cannot provide them with a specific diagnosis . They feel that if we can't find the problem , we will not be able to find a solution . Fortunately , this is not true . While we are very good at being able to pinpoint problems , assisted reproductive technology today is very good at bypassing these .

We are not able to make a diagnosis for most patients who have had recurrent miscarriages . Their reproductive system is anatomically normal, as are their chromosome tests . We are completely in the dark as to why she is miscarrying , because our tests are fairly crude, and not precise enough.

Imagine the amount of stress the poor patient goes through ! She doesn't know whether she should try getting pregnant again , and is very scared even when she does get pregnant , because she is petrified that she will miscarry again. She not sure whether she needs treatment , and if so , what treatment she should take .

Different doctors advice different treatment options . Some talk about immune therapy , others offer surrogacy , while some state that using donor eggs is their best option.

Interestingly , for some of these patients, IVF with their own eggs can be a useful treatment option . This may sound counter-intuitive. After all, they are getting pregnant on their own, and do not have a fertility issue, so why should they spend money on doing IVF ? Isn’t IVF a treatment for infertile patients ?

Interestingly, IVF improves reproductive efficiency by telescoping time . In the natural course of events, she would produce only embryo every month , and some of these would be genetically abnormal. It would take her a long time to produce a genetically normal embryo , which would give her a healthy baby , because this is such a random affair. The beauty about IVF is that it allows us to create multiple embryos in one cycle .  We can help her to make 10 embryos in one cycle, and then allow them to compete amongst themselves , so that we can pick the best blastocyst, and then selectively transfer this in her uterus. Rather than adopt a hit and miss approach , which could consume a lot of time , we are helping her to maximize her chances of hitting the jackpot quickly , by resorting to IVF . Think of someone who's buying a lottery ticket . Rather than buy just one lottery ticket every month , over a period of a year , she could buy 12 lottery tickets in one month , and hope that one of the tickets she bought could be a winning one . Yes, it's true that this is a gamble . Whether she buys a ticket one at a time, or all at once , this will not affect the chances of selecting a winning ticket.  However, she can trade money for time, and save herself valuable time by having many embryos to select from on one cycle.

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