Saturday, April 27, 2019

What should we change in the next IVF cycle ?

A patient sent me this email

Dear Doctor, 

As you know, my first cycle failed, even though everything was perfect, and I am heartbroken !

You have suggested that we stick to the same medical protocol , but I have a bunch of questions which I would like you to  answer .

1. Should we opt for PGS or test the endometrium health to assess the exact issue?

PGS reduces pregnancy rates in my opinion.

The ERA test is also a waste of money ( but very profitable for doctors to do !)

2. Can the timing of the embryo transfer be an issue? I usually used to ovulate around day 12 during the IUIs, isnt the endometrium receptivity the best at this point? We transferred at day 15 during this cycle, looking to understand how does this work exactly for my own mental satisfaction?

We don't transfer according to the calendar date, but according to the time when endometrial receptivity is optimal

3. Could/should I opt for alternative medicines like acupuncture or a detox program like panchakarma? Should I go on to a specific diet program? 

There is no harm in exploring these options, but we don't have any medical evidence that they improve pregnancy rates

5. Should we be screening for any auto immune disorders which could be a possible reason for failure ?

 6. If we do nothing different will the result not be exactly the same?

No - it's just that it takes time to make a baby, and you need to be patient !
If a fertile couple doesn't get pregnant after trying actively for 6 months, this does not mean they can't get pregnant in the 7th month !

7. What are the success rates for first time IVF?

30% per cycle  when we transfer a single blastocyst - remember that human reproduction is not an efficient enterprise , and it takes time to make babies in the bedroom as well!

I understand your heartache and frustration. There is a lot of pressure on the doctor to do something
 " new" or "different" - but newer is not always better ! Embryo implantation is an inefficient biological process, and we need to live with its limitations. 

Please don't expect instant gratification and please have realistic expectations !

What to find an IVF clinic which respects your time and intelligence ?

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