When we don't have all the answers to the infertile couple's questions

Patients who come to us for IVF treatment have a lot of questions ! They want to know why their sperm is of a low quality or why the fertilization rate was so low. If their embryos were A-grade, they want to know why they didn’t implant ; or why there is no improvement in their uterine lining even after treatment.

There are a slew of questions that come our way and in most instances, we have no answers to give them and so, the only truthful answer is – “I really don’t know”.  Maybe the more appropriate answer would be- “ Medical science doesn’t know”; this is because when I tell the patient that I don’t have an answer for them, some of them doubt whether I’m competent enough and whether I am sufficiently well-informed.

Harboring Unrealistic Expectations

The truth is that patients tend to have extremely unrealistic expectations from their doctors. They want them to be the “fixers” and want the doctors to take the concern of infertility off their shoulders. Irrationally, they want a doctor who will be able to give them a 100% guarantee that he will be able to help them conceive and one who will confidently tell them that this is exactly what he will be able to do.

I would like to say here, that if a doctor categorically tells his patient this, it would be no less than a sham.  Biological systems are complex and messy and there is no concept of having all the answers. Many doctors will get their patients to run numerous tests- this is how they make a “diagnosis” and also keep their patients happy that they are actually doing something. Sure, these tests do give us some answers; but most of the results are totally pointless and irrelevant to the IVF issue.

Doctors Should Come Clean

Since these doctors don’t really have any answers, they go onto a complete tangent and treat these abnormalities, losing track of the issue on hand.  If you ask me, it’s much better to come clean with the patient and tell them that we don’t know. In the same breath, I’d like to say, that patients don’t need to go berserk when they hear their doctor say this.

After all, we aren’t researchers and don’t run a research institute; we are an IVF clinic that tries to help infertile couples have a baby. The point to keep in view here is that though we may not always know what the problem is, we have the knowledge, technical expertise and experience to craft solutions that allow us to bypass the problem, and this is really for the best.


I always tell my patients that the quality of my answers will be directly dependent on the quality of the questions they shoot at me, and if they ask pointless questions- the truthful answer from me will be- “I really don’t know”.

The Best Way to Battle Uncertainties

It’s important that patients recognize that their doctor isn’t fobbing them off with “pseudo answers”. The undeniable fact that we all have to deal with is that life is riddled with uncertainties and IVF is no different from any other fields, in this respect. The minute we learn to accept this fact, it will become significantly easier for patients as well as doctors to deal with this in a level-headed manner.

When a patient asks me a question, I sometimes deliberately say, “I don’t know the answer, let’s look it up.”  I’ll deliberately do a search for them, and go to a curated and reliable website, and we’ll read the answer together.

Doing Things Differently

This is antithetical to what I was taught at medical college and it was hammered into us that just as treating a patient is important, so is instilling confidence in them. And some doctors follow this dictate in a blindfolded manner and pretend to know everything there is to know. But as Abraham Lincoln said- “You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time”.

Some patients aren't too happy with my answer, because they don't like being treated by a doctor who doesn’t have all the answers; however more mature patients appreciate the fact that I am being honest with them.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!