Tuesday, December 19, 2017

Why do patients find it so hard to repeat an IVF cycle ?

Patients know that the success rate in a single IVF cycle is not 100% and they may require 3 - 4 cycles to get pregnant. However, lots of them drop out after one cycle , and are very reluctant to do a second . I sometimes wonder why this happens !
After all, an IVF cycle is a fairly straightforward treatment, which doesn't need hospitalisation or surgery, and requires only 4-5 visits to the clinic. In a good clinic, the treatment shouldn't be stressful at all.
However, unfortunately, the reality is that the way IVF is done in a lot of clinics does add a lot of unnecessary burden to the patient for multiple reasons.
Often there's a complete lack of transparency, which means patients don't have any idea what's going to happen on a particular day. Everything's done on a very ad hoc basis, so that they're completely clueless . They often have to spend hours in the clinic, waiting for someone to tell them what to do next. They have to put the rest of their life on hold, because they are stuck in suspense at the center all day long. Taking leave from work ; explaining to relatives why you're not being able to attend family functions; and having to make excuses to friends as to why you cannot party, because you are trying to hide the fact that you are doing IVF causes a lot of stress. The biggest tragedy is that this is completely unnecessary.
There's way too much waiting in most IVF clinics, because doctors perversely seem to take pride in having a waiting room which is overfull with patients.  This seems to stroke their ego, because it confirms who successful and important they are.
I can now see why patients are called patient ! They are to made to wait for scans; made to wait for the blood test results; made to wait to talk to the assistant doctor; and made to wait for the final instructions from the top doctor.
All of this is completely unnecessary in a well-run clinic. What's worse is that patients are made to come to the clinic every single day ! This makes no biological sense, because follicles grow at 1 2 mm per day, so doing frequent scans doesn't really change the treatment plan.  However, many doctors pride themselves on being very thorough and meticulous , and end up overmonitoring their patients, even though this does not improve IVF treatment outcome.  Ironically, patients are very impressed by how careful  the doctor is, because they don't understand any better !
To add insult to injury, some of the injections which doctors use (for example, the progesterone injections after transfer ) are oily and extremely painful . This is unnecessarily unkind, because we can administer the progesterone as a vaginal pessary, which is more effective and much easier ! Interestingly, it's only the US doctors who continue to inflict these painful shots on their patients - doctors in Europe are much kinder !
Lots of clinics overtest and overtreat their patients, using unproven injections such as low dose heparin  (  Clexane). These are expensive and unproven, but these aggressive doctors justify their use by citing anecdotal successes , and justifying these unnecessary prescriptions under the forgiving blanket designation of empirical therapy. These doctors enjoy overmedicating patients and giving them lots and lots of medicines, because they want to show that they are doing their best in order to get the patient pregnant. Patients naively continue to believe that more must be better. These include expensive medications such as growth hormone injections and intravenous immunoglobulins,  and patients are fooled, because they believe that the more expensive the medicine, the better it must be ! All these tests and treatments add to the burden of the patient - both physically and emotionally, as well as financially !
Now, patients know that IVF treatment is expensive, but they get sticker shock when they end up having to pay for all these unexpected add-ons , which no one tells them about in advance. The irony is that all this additional meddling is completely unnecessary - and rather than improve the patient's success rates, they just improve the clinic's profit margins !
Finally, there is the uncertainty of IVF which makes it so hard to deal with. Patients understand that the outcome is uncertain, but it can be hell living through the horrible two-week waiting period - especially when inconsiderate doctors force you to rest in bed for no rhyme or reason ! Each day of the dreaded 2ww can appear to be as long as a week - and it can be very hard to screw up your courage and be willing to subject yourself to that torture a second time.
What makes the process much worse is that most doctors refuse to share information with you. They don't even tell you basic stuff such as many follicles are growing; what your blood test results are and what they mean; how many eggs they collected; and what your embryo quality is. Sadly, the majority of clinics still refuse to provide embryo photos to their patients, and cut corners by not complying with global bets practices.
This is why patients often find themselves completely in the dark - even after the cycle is over. They end up wondering , "Even if I repeat the cycle, what would the doctor do differently the next time around ?" And when the doctor says, "I will do the following additional tests and treatments for you," the patient's unexpressed question is, "Then why didn't you do them the first time around?"
Their confidence in the doctor's medical competence gets shaken up when the cycle fails, which is why they're very reluctant to do another cycle.
This is a big tragedy, because we know that if patients are willing to be patient, their chances of getting pregnant in a second and third cycle remain extremely good.
It's time IVF doctors learned to be kinder to our patients !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !


  1. Anonymous1:45 PM

    Good and informative article.But in most of the cases even we cannot ask too many questions as we fear the doctor might get offended. Doctors think they know best and why wasting time to explain such things to patients who don't even know about this. I know this as I just has a failed cycle. this is at a reputed IVF clinic in Bangalore. I was not given the photos, I didn't even know what were my blood test results before transfer. I have taken your email id and will write to you about my case. But honestly I don't know even if a 2nd IVF would work.I am already too demoralized.

    1. Any doctor who gets offended if a patient asks questions is a bad doctor !
      It's your right to ask questions - and it's the doctor's duty to answer them !
      This is why it's important to do your research before starting an IVF cycle - you can't leave everything up to the doctor - this can be an expensive error !


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