Tuesday, January 19, 2016

The irrational IVF doctor

When patients fail an IVF cycle and go back to their doctor to find out the reason for the failure, they are advised to do a whole battery of tests ; and lots of additional treatment options are then offered for the next cycle, with the promise that these additional interventions will improve the chances of success. 

Thus, patients are advised to do an ERA ( endometrial receptivity assay)  to check for endometrial receptivity, the explanation being that this test will help the doctor to find out why implantation failed in the earlier cycle. Some doctors will suggest that patients do PGD so that the genetically normal embryos can be identified and transferred. Others will put the patients on empirical therapy with GH ( growth hormone ), with the explanation that this will help the patient to grow more eggs of better quality  ; or will suggest the patient take low molecular weight heparin ( Clexane ), in order to improve uterine blood flow and improve the chances of implantation.

Now there are rational explanations for doing all these tests and taking all these additional injections, but the fact remains that none of these have been proven to be effective.  Thus, low dose heparin can be painful and expensive , and growth hormone costs a bomb, and has never been shown to improve pregnancy rates. But, when patients fail IVF cycles, doctors offer them these additional expensive and exotic treatment options , without bothering to explain to them that these are unproven.

They will justify the treatment by referring  to anecdotal success stories, without telling patients that there is no evidence to show that these additional treatments help. Anecdotal success stories mean little - after all, a swallow does not make a summer. However, patients who have failed IVF treatment are very vulnerable , and are not sophisticated enough to push back or do their homework, which is why they often say yes. They are happy to clutch at straws and try something "new and better".
Many patients are quite naive, and believe that the more expensive the test or treatment which is offered, the better it must be !

However, more is not always better, and sometimes just repeating the cycle without adding unnecessary expensive bells and whistles is the best option.

Not sure if your IVF doctor is providing you with good advice ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

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