Tuesday, August 09, 2016

The difference between theory and practice when doing IVF

In a perfect world , all an IVF doctor would need to do would be to follow the protocols written down in medical text books , and medical practice would be much simpler than what it is. The truth is that there are lots of additional real life factors which influence the doctor's decision making , which is why medical practice can be so different from what text book guidelines suggest. Thus we have to consider things like the capacity of the patient to tolerate uncertainty and pain ; her financial status; whether she stays in Mumbai or comes from overseas; whether this is her first cycle or her fourth cycle ; and whether she's reaching the breaking point , or whether she's still raring to go.

Now all these are intangible factors which are hard to quantify . You have to consider them when you're making decisions in partnership with the patient, even though they may not be listed in the medical text books. They are important variables, which need to be weighed along with the medical variables, so that can make a decision which is right for the patient sitting in front of you.

This is why a one size fits all approach cannot possibly work in medicine , and this is the major shortcoming with lots of medical guidelines . They don't have the flexibility to be able to incorporate all these complex variables into a medical flow chart, but each of these can make a world of a difference to the patient . They can completely change the advice we give to that particular patient.

If this were an ideal world, where the patient didn't have to worry about money and she  lived in Mumbai, then my preferred approach for all IVF cycles would be to routinely freeze all blastocysts and then call her back for a frozen transfer. This would be the utopian standard - the ideal, which would give us the highest pregnancy rate. However, in real life , a lot of patients will find it very hard to comply with this , because of time pressures or cost constraints . We then need to tweak the treatment plan we formulate for patients , even though this may reduce their success rate.

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