Wednesday, September 07, 2016

Why implantation failure is a useless diagnosis

When an IVF cycle fails, the first question the  patient asks the doctor is, "What went wrong?". The standard reply is, " Your diagnosis is failed implantation." The patient is happy that the doctor has finally made a diagnosis , and he is comforted that now that the doctor knows what the problem is, he'll be able to find the solution.

However, the reality is  that 'failed implantation' is a wastepaper basket diagnosis. It's just medical jargon which doesn't make anyone any wiser . All it does is convey to the patient the impression that now that the doctor has a handle on the problem , he will be able to fix it.

This is false solace. The truth is that this "diagnosis" provides us with no useful actionable information, and doesn't change any of the medical decisions which we can make as far as the next cycle goes.

This is because implantation is a black box. Once we put an embryo inside the uterus, we have no idea what's going to happen to it. After the embryo transfer, we're groping in the dark. We need to share this ignorance honestly with our patients . The truth is that just like we don't know why some embryos fail to implant, we don't know why some embryos will implant. However, no successful IVF patient has ever asked me - Why did my embryo implant ? They just take it for granted that they will !

The good news is that while the " failed implantation " label is a coverup for our lack of ability to study implantation, this doesn't mean that we can't offer effective solutions. We may not be able to identify the problem , but we can often solve it effectively by bypassing it !

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