Friday, February 03, 2017

IVF failure rates vs IVF success rates

The commonest question a patient asks an IVF doctor is, "What are my chances of success?" What are the pregnancy rates in your clinic?"

This is perfectly natural - after all, the patient has come looking for a baby , and they want to know how well the doctor can gratify this desire for them. Doctors are happy to talk about IVF success rates, but the problem is that this creates a framing bias . This is because when you talk about successes , you tend to gloss over the possibility of failure.

The danger is that this sets up unrealistic expectations, which means patients are very optimistic and hopeful when they start their IVF cycle.  They are sure their IVF cycle is going to succeed, and when it fails , this creates a backlash. Patients are extremely upset, and they will often vent their anger on the doctor . Now it's not that the doctor was responsible for the failure, but because he didn't discuss this possibility explicitly with the patient up front, he set up the patient for unnecessary heartbreak and disappointment.

It's completely normal and natural for IVF doctors to talk about success rather than failure. After all, who wants to be a wet blanket? Who wants to take the risk of putting the patient off by disheartening   her ? She may think you are a very negative doctor, and will go off to the competing clinic across the road  . Few patients have the maturity to appreciate a doctor who is blunt, frank and forthright - they'd rather go to someone who promises them hope , even if this is false!

This is why IVF doctors are so sweet at the time of the first consultation.  They want the  patient to come to them for treatment, which is why they frame the situation in a manner which increases the chances of the patient signing up with them, rather than with another doctor. Now, while this might be good for the doctor's practice, it's self-serving, and doctors need to be aware of their personal prejudices when counseling their patients.

I believe doctors don't need to prepare IVF patients for success ! After all, if the patient is successful, she's going to be extremely happy with you,  and will send lots more patients to you. However, you do need to prepare the patient for failure. if you fail to do this, then in case the cycle fails (which it often does), then she doesn't go to pieces, and is able to be resilient and bounce back.

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