Wednesday, December 23, 2015

Why the diagnosis does not matter for IVF patients

I did an interesting consultation today. The patient was a neurologist herself, and her first question was, "I want to know why I'm not getting pregnant. Please tell me what my diagnosis is." She'd already failed 3 IVF cycles and was desperately looking for answers.

I feel that the quality of my answer depends on the quality of the patient's question and I explained to her that this was a poor quality question . At the end of the day, we don't want to go looking  for problems - we want to find solutions ! Our focus in our clinic is on getting our patients pregnant and giving them a baby , rather than trying to find out exactly what the problem is. This is something which is better done in research clinics ! The job of an IVF clinic is to help patients to complete their family.

She was extremely unhappy and dissatisfied with my answer because she felt I wasn't being scientific at all. Her belief was that the rational practise of medicine required that we first establish a diagnosis, so we can find out what the problem is, and then go ahead and treat it.

I can understand why this is the way a neurologist would practise medicine, but this is not the right approach for IVF clinics.  This may not be very intuitive, and it may appear that we are taking shortcuts, but this works very well in clinical practice . Physicians are obsessed with making a diagnosis and assigning patients to the right bucket, because they enjoy thinking analytically and using their cognitive skills. However, this clinical expertise is of limited utility to the IVF patient, and while it may dazzle medical colleagues, it really doesn't help the patient achieve her goal of completing her family. The final common pathway remains the same - IVF; and why bother to establish the exact diagnosis, if this is not going to change the patient's treatment options ? After all, irrespective of whether the actual diagnosis is male factor infertility or unexplained infertility, our treatment options are limited .

Doctors need to learn to be more patient-centric and work backwards . They need to start from the patient's goals, and then help her to reach them , rather than mindlessly use a textbook cookbook style of practising medicine which is not appropriate for the infertile couple. I am not saying that tests don't need to be done - it's just that they should be ordered selectively, and only if they affect the patient's treatment options. There's no point in ordering tests, just because we can !

Our focus is a success based approach, and our technology for identifying problems is still not as good as our ability to bypass problems, so that we can give patients what they want - a baby !

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

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