How optimistic should an IVF specialist be?

This is always a difficult problem for an IVF doctor and I work hard at trying to find the right balance between being optimistic and realistic when talking to my patients.

It's easy to be optimistic when a patient comes to you for a consultation. You feel your IVF clinic is the best, and because you want the patient to sign up for treatment, you are happy to promise her the earth and the moon.

It's also very easy to be optimistic at the time of the embryo transfer. " These are great embryos ! Your uterine lining is perfect and the transfer went off smoothly, so you have a great chance of getting pregnant ! " And it's easy to take pride in the fact that you did a good job when the beta HCG is positive. However, what  happens when the HCG is negative?

Your optimism caused the patient to  build up  her hopes, and even though her head understands that the pregnancy rate in an IVF cycle is not 100%, in her hearts of hearts she is certain she's  going to get pregnant because of your positivity.

However, when the cycle fails, she goes to pieces. To add insult to injury, this is often the time when doctors abandon the poor patient, so that she has nowhere to turn to.  She feels lost and cheated.  “When the doctor was so sure that I would get pregnant when doing the embryo transfer, then why did the cycle fail ? Did I do something wrong? Or did the doctor lie to me ? Did he do something wrong?"  When she goes back to ask her doctor this question, she doesn't get any straight answers.  The  doctor comes up with all kinds of cock-and-bull reasons, and says, "Let's do some more tests to try to figure out why you had " implantation failure".

The poor patient is then left wondering, "Why didn't you discuss the possibility of failure at the time of the embryo transfer? Why are you telling me this after the result is negative?" She loses trust in that doctor - and starts losing trust in all IVF doctors. She starts believing  that all IVF doctors just talk sweetly - that they over-promise, and under-deliver.

While it's easy to be cheerful , I do my best to make sure my patients have realistic expectations, and are ready to accept for the possibility of failure. Sometimes patients complain -  "You're so negative and pessimistic. You're always talking about failure and preparing us for the fact that the cycle may not work. We'd much rather have a happy, smiling, cheerful doctor who tells us all is going to be well."

It's easy for me to be optimistic because  I am an optimist by temperament. However,  I need to be careful that the patient's expectations don't get too high, because if the cycle fails, she will go to pieces and will find it hard to recover. Every patient is different, and I try to adapt my style to make sure that the patient has realistic expectations of our treatment.


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