Wednesday, July 01, 2015

IVF Doctors Must Recognize When Enough is Truly Enough

Reproductive technology has advanced in a big way and in many ways it seems like there really is no shortage of the different things we can do for our patients who come in for infertility treatment. It seems like everything is within reach and the alphabet soup of procedures we have seem impressive and promising. So whether we use IVF, IUI, HSG’s, ICSI, ZIFT, GIFT, PGD etc for  our patients,  the hope they come to us with, and the faith they have  in us, is what  keeps  us going.

Astounding Number of Treatments

Just look at the myriad things we do to help infertile couples have the baby they want:

If a woman has no eggs of her own, we get them for her from donors
Ditto when a man doesn’t have any sperm
Epididymal Aspiration or Testicular Biopsy with ICSI (intracytoplasmic sperm injection) has changed outcomes for men after vasectomy or those who have azoospermia
Women who don’t have a uterus can opt to use a gestational carrier
Many serious gene defects can also be weeded-out and ousted from the gene pool of the next-gen using PGD (preimplantation genetic diagnosis)

Playing God?

Little do we realize that the number of things we can do is truly astounding; but then, so is the cost. At our clinic in Colaba, Mumbai, we treat patients from the city, across the country as well as a large number of overseas patients. But there are times when I have felt a distinct reluctance on the part of some couples, to go beyond a certain stage (even to IVF); in case other plans don’t actually pan out the way they felt they would.

Patient’s Concerns

In the course of consultations, some patients voice their concerns about creating a life that they may not be able to protect and nurture. Many of these couples have the financial muscle to opt for one of our almost magical cures, but sometimes they just opt not to take that route at all, largely for personal reasons. Even in situations such as these, certain explanations can be given and concessions made, which can mitigate their concerns and provide options which are more acceptable- e.g.:  egg freezing, instead of going ahead and fertilizing the eggs with sperm.

Then there are some patients who stop short of opting for some of the most advanced infertility techniques because of financial constraints. After all, just like emotional capital, financial capital isn’t an infinite resource. There are times when patients are unable to bear the emotional and financial burden of going through multiple cycles and their resolve buckles.

Adoption Options and More

Of course, the last recourse of adoption remains; but not many are open to it or it could be too expensive for some patients too. Donor egg cycles can also be prohibitively priced as current day donors are getting much more to donate their eggs. When it comes to infertility treatment, factoring this possible expense is quite an important consideration too.

Some Odd Cases

Apart from this, there are many patients who try it all, but have not got pregnant. In some cases, these couples have just skipped an important step along the way and headed straight for IVF and it hasn’t worked.  In the past, I  have attended  to patients who have come in for a second opinion and have been diagnosed with endometriosis and implantation failure;  at times, these patients may have gone through  multiple  IVF  cycles, but have never  got a laparoscopy done. Once the underlying problem was detected via laparoscopy and then treated appropriately, they were able to conceive naturally.

The Baffling Cases

We also do see some couples whose cases baffle us and there seems to be no apparent reason for their infertility. They have gone through every possible test and procedure at different clinics (and maybe ours as well) and still are unable to conceive and nothing seems to work! As an IVF specialist I know that there are times in this doctor-patient relationship, when it’s time to put up the stop sign.

Being an eternal optimist, and a person who wears his never-say-die attitude on his sleeve, I do find it very hard to go ahead and admit defeat. But as doctors it’s our duty towards our patients to recognize the signs and know when it’s time either to take a break or stop trying. Sometimes the patients agree, while at others they don’t.

The Patient’s Prerogative

I always hope that all infertile patients who are consulting IVF doctors are able  to maintain a certain amount  of control  over  the rough  road of infertility; that they should have a  very transparent relationship with their  doctors, where they are able to have this discussion, if required. Not every IVF patient gets pregnant, but every one of them should have the prerogative to stop – even if the doctor feels that enough is not enough!!

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