Saturday, July 30, 2016

Why poorly informed patients get poor quality IVF treatment

I received this email from a patient.

Hope this mail finds you in best of your health , as you may tell from trail mails , we have consulted you earlier also . My wife has failed 2 IVF cycles in Delhi.

Total embryos developed : 7
transferred in first cycle : 3 , 4 were frozen

Transferred in second cycle : 3 , 1 was declared unfit while thawing

They were all grade A embryos , transferred on day 2. We do not have any pictures of embryos.

Hers is a case of unexplained infertility

Sir, we have been going through these treatments since last two years and as many of the patients , now running out of patience.Please help me by giving clarity on areas below :

How many cycles should we attempt for IVF ?
How many cycles before we move to donor eggs?
We are also planning to attempt surrogacy simultaneously through donor egg

One of the reasons I provide  a free second opinion service is because it breaks my heart when I see patients get poor quality IVF treatment. IVF clinics seem to have sprung up at every street corner in India, and many gynecologists style themselves IVF specialists after attending a one-week "diploma" course in an IVF center. The tragedy is that patients are not sophisticated enough to be able to differentiate between a good clinic and a bad clinic, which means it's very for an unscrupulous doctor to take them for a ride. The reason I care is because all IVF clinics then get tarred with the same brush, and patients will no longer have any confidence in even the good IVF specialists. They will end up remaining childless, because they will refuse to attempt IVF, and thus deprive themselves of their best chance of getting pregnant. If good IVF specialists keep quiet  and allow the bad ones to continue cheating their patients, we are inviting a regulatory backlash from the government, which in its typically ham-handed way will pass rules which will make life miserable for all infertile couples.

Let's look at the above email.

It's obvious is that this patient has selected a poor quality clinic.

For one, they transferred embryos on Day 2. No good clinic does this anymore. The standard is a  Day 5 ( blastocyst) transfer, which has a much higher implantation rate; and also reduces the risk of a multiple pregnancy. Any clinic which does not have the confidence to grow embryos to Day 5 is a poor quality clinic. I know these are strong words, but there is enough research to back up this statement, and I would be happy for someone to disprove this !

Secondly, they failed to provide embryo photos. This is diagnostic of a bad IVF clinic, because this means they are trying to hide information from the patient.

Thirdly, they lost an embryo after thawing it. In a good clinic, survival rates after thawing vitrified embryos should be closed to 100 % !

While I am disappointed with the poor quality of care this patient received, I am even more disappointed with the poor quality of his questions.   This shows that he is not thinking clearly and has become no wiser even after spending so much money ! There is no need for him to use donor eggs; and to combine both donor eggs and surrogacy is the worst possible option, because it is both the wrong medical choice, and also extremely costly. You may think I am being excessively harsh by criticising a patient - after all, he isn't a medical expert, so why blame him ?

However, I do believe that patients should take responsibility for making their own medical decisions - they simply cannot afford to leave everything upto God, or their doctor anymore ! And it's irresponsible of educated patients to take such a passive uninformed approach in this day and age, where so much high quality medical information is easily available free of cost from reliable websites.

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