Thursday, January 07, 2016

Why are the success rates of the new IVF clinics in India so low ?

One of the big problems with government medical colleges and hospitals in India today is that they have failed to keep up with the times. Thus, there is practically no public hospital in India which offers IVF treatment. However, these hospitals are the ones which provide training to future gynecologists. This means that the gynecologists who graduate from these colleges are half-baked because they have no practical exposure to IVF treatments.

The senior professors are dinosaurs who have never done an IVF cycle in their life; and refuse to learn. They feel threatened because they are ignorant about IVF technology, and they will not allow their younger colleagues to learn these either. As a result of this dog in the manger attitude, the young gynecologists who graduate from these premier medical institutes become second class gynecologists when they enter practice, because they have no exposure to IVF. They find it hard to attract infertile patients because their training is incomplete - they have crammed lots of theory, but have no practical skills in doing IVF.

When they find that they cannot offer state of the art IVF treatment to their patients, they feel
handicapped , and try to compensate for this deficiency by acquiring additional training. Some will go abroad; others will do a fellowship with a leading private clinic; and some will join as junior faculty members in large private corporate hospitals , in the hope that they can learn by osmosis.

However, they get very limited hands on training in these settings, because  doctors in private practice will not allow inexperienced juniors to acquire skills by using their patients as guinea pigs. This is why most of these young gynecologists are forced to sign up for a short training course, with the hope that they will be able to attract patients based on this certification, and will then learn the skills by winging it in real life.  Some of these courses are better than others ( for example, those which are certified by the FOGSI ) , and hopefully they meet a certain basic standard. However, I always worry about how a junior doctor can become an IVF specialist just by spending 7 - 28 days learning these techniques, many of which can be extremely challenging and complicated.

Of course, once the doctor has this " certification" , he can then call himself an IVF specialist, and start treating his poor, unsuspecting patients, who have no way of determining how good ( or bad) his technical skills are. This is why so many IVF patients end up in trouble, because their doctors often do not have the required expertise or the experience to deal with difficult problems.

This is one of the reasons why the success rates in a lot of new IVF clinics ( many of which are run by doctors who don't have enough exposure to IVF) have such dismal success rates.  Some of them will have the grace to refer the patient to a genuine specialist, but unfortunately these are few and far between, as a result of which we now have a lot of cobbled, makeshift solutions.

For example, some will "import" the entire IVF team and do IVF cases in batches.  These are all sub-optimal solutions, and it's high time medical colleges started providing training in IVF and endoscopy for all gynecologists whom they train. Ideally, the Medical Council of India should refuse to recognise any OB/GYN Dept which does not offer IVF  treatment - this is the only way of ensuring that they get their act together and can no longer get away with providing their residents and patients a raw deal by refusing to keep up with the times.

This is why it's important for patients to ask their IVF doctor where he got his IVF training ! If he refuses to give a straight answer, this is a red flag and you should worry a lot !

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