Is your IVF doctor using you as a guinea pig ?

All of us believe that as medicine advances, IVF pregnancy rates will constantly keep on improving, and this is perfectly normal. After all, science does progress , and IVF pregnancy rates today are much better than what they were 10 years ago.

Unfortunately , this expectation also gives rise to the phenomenon of treatment creep . Doctors start introducing all kinds of new ancillary procedures , even though they haven't been proven to be effective.

Part of the problem is that many doctors are very optimistic that something which is new will be more effective better than the current solutions. We are always under pressure to try out the latest technique , and most doctors are competitive, and happy to be the "first" one to introduce something new !

The pressure to "publish or perish" also means that researchers and scientists spend a lot of money on publishing positive results papers in academic journals. Sadly, most of these results can't be replicated by others !

Both pharma companies and medical device companies are also happy to sell what's new. After all, they can charge a premium for this, which means they advertise and market this heavily, at medical conferences and in medical journals.

Doctors are under a lot of pressure from patients to do something new - or something different.  After all, what 's the point of trying out the old stuff again, if it has failed once ?

And because doctors are human and get carried away by their anecdotal successes , it's easy for them to justify doing new procedures, even when they haven't been proven to be helpful. And the fact that this gives them an excuse to charge more is icing on the cake for them !

Are you worried that your doctor is using you as a guinea pig ?

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Why it's safe to take medications after your embryo transfer

 A lot of IVF patients are very worried about taking any medication at all during the 2ww( two week wait).

For example, if they get a cough or a cold or a diarrhea, they're not sure whether it's safe to take medicines to treat this.

The reason is they're worried that these medicines will have an adverse effect on the embryo which is in their uterus. They know that some medications are dangerous during pregnancy , and are worried that these will harm their embryo.

The truth is that it's safe to take any medicine you need to during your 2ww, until your HCG test is positive.

This is because even though your embryo's inside your uterine cavity, it's still not implanted. Because it has not established a blood supply from you , the drugs you take will not be able to cause any harm to your embryo because they can't reach it through your blood stream.

This is why you don't need to worry at all !

Just like women continue taking medications after having sex in their bedroom, there's no reason for you to take any special precautions about any medicines after the embryo transfer either.

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Why it is safe to take all medications during the IVF 2ww

IVF can be a blessing

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When IVF can be a blessing

Being infertile can be stressful, and so can going through IVF treatment .

However, there is always a silver lining to every cloud, and we need to remember that going through IVF can be a blessing as well !

Thus, we know that IVF patients become better parents than ordinary parents. This is hardly surprising, given the fact that you've worked so hard in order to get a baby !  You don't take your baby for granted, unlike most other parents, and spend much more time and energy on parenting, simply because you realize how precious children can be.  You are grateful that you have them, and treat them as a blessing. IVF children actually have a head start in life !

And it's not just that IVF patients make better parents - they make better spouses too ! If you have the maturity to withstand the stress of an IVF cycle, your marriage is going to be much stronger than an ordinary marriage.

Finally, IVF helps you become a better person, irrespective of whether your IVF cycle fails or succeeds, because it teaches you to cope with adversity, and teaches you how to manage your emotions.  Going through suffering helps you become more empathetic , and a better human, who is more willing to help others !

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

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The role of "fate" and "luck" in IVF

Embryo implantation is a still a "black box" as far as medical science is concerned, because we can't predict or control which embryos will implant. This is hardly surprising, given that it's a complex biological process, which involves an intricate interchange of signals between the embryo and the uterine lining.

There are lots of factors which determine success, and while we know what some of these are, many are still beyond our comprehension.

For example, we know that a top quality embryo has a better chance of resulting in a pregnancy, as compared to a poor quality embryo.

However, we also know that not every perfect embryo transferred into a perfect endometrium will implant! This causes a lot of heartbreak and distress, but this is because there are many other factors which determine success, which we don't know enough about ! These include: genetic factors; epigenetic factors; and immunological factors , all of which have still not been analysed in sufficient detail.

At present, we are forced to include these under the rubric of "luck", "karma" and "fate" - which aren't very accurate or helpful ! Patients want more accuracy from their doctors !

Thus, if a patient does not get pregnant after the transfer of a top quality embryo into a receptive endometrium, we attribute this to "bad luck". Often, all we can do is repeat the cycle until her luck changes !

It's partly because there is so much about IVF that we don't understand that both IVF specialists and patients are so easily swayed by anecdotal case studies. This is why there are still so many useless and unproven "treatments" which plague IVF today, including: endometrial scratching; endometrial receptivity assays; PGS ( preimplantation genetic screening); and treatment with "stem cells". While these are very profitable for the clinic to offer, the truth is that they haven't been shown to improve clinical pregnancy rates in clinical studies.

This is why research and development is so important. However, it's not fair to use patients as guinea pigs - and to charge them for expensive and unproven "treatments" under the guise of their being the "latest technology" .

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

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The known and the unknown in IVF

One of the reasons IVF outcomes are so unpredictable and uncertain is because it's a complex biological system, and there are lots of factors which determine success.

It's useful to think of these in terms of known factors ; and unknown factors .

For example, we know that the quality of the embryo ; and the endometrial thickness and texture will influence the chances of embryo implantation.

However, we also know that not every perfect embryo transferred into a perfect endometrium will implant, which clearly means there are lots of other factors which determine success, which we don't know enough about !

These include: genetic factors; epigenetic factors; and immunological factors , all of which still need to be studied and analysed.
At present, we include these under the rubric of "luck" and "fate" - which aren't very accurate or helpful terms !

This is why research and development is so important, and advances in reproductive science will ensure that the number of known factors will increase , while the unknown factors will progressively decrease.

However, it's still not possible for us to be able to measure or improve all the unknown factors, which is why we still can't predict which IVF cycle is going to be successful , and which one isn't.

We try to use all the technological tools available at our disposal, but our answers are not perfect and we need to live with this !

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

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How IVF patients can use Dr Google intelligently !

A lot of husbands get worried because their wives spend so much time on Google.

After all, being infertile can be stressful and infertile women are hungry for information , which Dr. Google provides in abundance !

This is especially true when you're going for an IVF cycle, but a lot of family members don't like women obsessing over IVF websites.

For one, they are worried that they will start thinking of themselves as being half doctors - after all, isn't half knowledge dangerous ? Yes, it is , but this doesn't mean ignorance is bliss either.

Their bigger worry is that they will start worrying needlessly, especially because so much of the information available online is unreliable. All this worrying can't possibly be good for them , because it increases their stress levels !

Yes, they have a valid point, and simply want to protect them from anxiety.

However, we need to take a supporting attitude, rather than being judgmental  ! The good thing about Dr. Google is it teaches you what you don't need to worry about , if you are a smart user.

It helps you understand what's in your control - and equally , what's not in your control, so you stop obsessing pointlessly over stuff you can't do anything about. Knowledge is power when used well !

This means there's no need to stop using Google, but it's important to learn how to use Google intelligently. The good news is that Google can teach you how to do this as well, by helping you to identify which websites are reliable, updated and accurate !

What to find an IVF clinic which respects your time and intelligence ?
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Why single embryo transfers are a better option

Many IVF patients want us to put as many embryos back as possible , because they want to get pregnant as quickly as possible, and they know that the more the embryos they transfer, the better their chances of conceiving. This is why some clinics will routinely put back three or four embryos at a time.

I actually think this is irresponsible , because it increases the risk of a multiple pregnancy. Some of these patients end up with premature labors, which means their babies spend months languishing in a NICU, and maybe handicapped because of the prematurity. Even worse, the doctor does a selective fetal reduction to "treat" a high order multiple pregnancy, and this causes the patient to miscarry and lose all her babies . You can imagine the amount of heartburn this causes !  This is why a single-embryo transfer is much safer.

Interestingly, the pregnancy rate is also better with a single-embryo transfer, which means you can have your cake and eat it too ! Please remember that you can't compare apples and oranges , and you need to compare a double embryo transfer with the cumulative pregnancy rate of two sequential single embryo transfers.

Let me explain. Suppose you have two embryos, and suppose the chance of each embryo implanting is 30%. Now suppose you put both the embryos at one time, then yes, the chance in that cycle will increase to, let's say, 45%.  However, if you don't get pregnant, you will have no spare embryos left, and will need to start a fresh cycle all over again. However, if you did only a SET, you can still transfer the single embryo. The pregnancy rate with this will remain 30%, which means your cumulative pregnancy rate is 30  + 30, which is 60%, which is higher than transferring 2 embryos at a time !

Of course, this applies only to good IVF clinics, which transfer only top quality blastocysts, and have a robust embryo vitrification program.

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

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