What should a patient do when IVF doctors disagree ?

Infertile couples are often very confused when they go to IVF doctors , because they get widely varying different opinions , and they're not sure whom they can trust.

There are many reasons why IVF doctors don’t agree with each other.

For one thing, our IVF technology is still not perfect, which means we still cannot even make an accurate diagnosis, and have to label many couples as having “unexplained infertility” because we cannot clearly and accurately identify the underlying problem.

Because no one really knows what the truth is, everyone interprets tests the way they want, based on their experience and preconceived notions, and there’s no right answer !

The second big problem is that there are two important variables which influence the diagnosis and treatment of infertility. One is called the “ trying time” -  how long an infertile couple has been trying to get pregnant; and the second is the fact that the”  natural history “ of untreated infertility is unpredictable.

Thus, even infertile couples who haven't been able to get pregnant for five years, could still perhaps get pregnant on their own, if they continue trying.

This is why the individual doctor's personal preferences are going to influence what the doctor advises the patient, because they are so swayed by their personal experiences and anecdotal success stories.

Thus, some doctors are aggressive , and will advise IVF for everyone, whereas others are much more conservative , and will want to explore simpler options first, before advising IVF.

Patients need to recognize this subjectivity, and find a doctor whose preference and philosophy matches theirs !

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/

Please don't abandon your embryos !

As IVF technology gets progressively better, we're able to grow more eggs and create more top quality embryos. Now we can't transfer all the embryos at a time, because of the risk of a multiple pregnancy, which means patients are left with supernumerary (spare ) embryos. We encourage all patients to freeze their spare embryos , because each embryo is worth its weight in gold.

Our technology for freezing and storing embryos using the technology of vitrification has become so good that survival rates after thawing are practically 100%, which means the pregnancy rate with these embryos is as good as with fresh embryos !  And the cost of doing a frozen –thaw cycle is much less because it's so much simpler and easier – you don’t need to take any injections at all !

So if you do have spare embryos, please freeze them. Yes, freezing will add to your cost up front, but it's a very worthwhile investment.

And the bonus is that if you do get pregnant with your first transfer, you can use your frozen embryos for your next baby, to complete your family !

What to find an IVF clinic which respects your time and intelligence ?
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Why testing for failed embryo implantation in IVF patients is useless

One of the big problems with IVF is the uncertainty which surrounds it – no one knows which cycle will work, or why perfect cycles fail.

What makes a bad problem even worse is that patients have unrealistic expectations of the technology. Sadly, doctors compound the problem by pandering to the patient's demands. They offer to provide answers by running many expensive, complex, exotic and esoteric tests, even though they know the reality is that these don’t provide any useful information.

This is because embryo implantation is a complex biological process, which we cannot control and we cannot monitor, and we still don't know which embryo will implant , and which ones won't.

Doctors are worried that if we tell the patient the truth – that we don’t have all the answers – that patient will no longer respect us . This is why we subject them to the “latest and newest”  tests, to demonstrate that we're trying to figure out exactly what the problem was.

However, this just means that we're taking the patient for a ride, because we don’t tell them to truth about the limitations of these tests, and that they won’t change their treatment options.

Yes, the patient ends up  spending a lot of money, and this is good for doctors because they can charge more, but the test results don’t provide any useful answers , which means the doctor remains in the dark – but he can cloak his ignorance using fancy medical jargon !

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

WhatsApp us at https://wa.me/919867441589/

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Why IVF doctors disagree

Infertile couples are often very confused when they go to IVF doctors , because they get so many different opinions , and they're not sure whom they can trust.

There are multiple reasons for why IVF doctors will often give widely varying opinions.

For one thing, a lot of our technology is still not perfect, which means we cannot make an accurate diagnosis in reproductive medicine. This is why two different doctors will interpret the same test result in diametrically opposite ways !

Also, we need to remember that making babies involves a couple, which means the fertility of a couple will be the sum of the fertility potential of both the partners . This is why answers are never in black or white - they are always shades of grey ! It's possible that if an "infertile man" marries a very fertile woman, he will be able to get pregnant.

Also, time plays a key role is the final outcome . Trying time - the time for which an infertile couple has been trying to get pregnant is a very important dynamic variable, which means the way we treat a recently married couple is very different from the way we treat one who has been trying for more than one year - even of their test results are identical !

The problem is that the natural history of fertility is difficult to interpret, because we all know infertile couples who  haven't been able to have a baby in the bedroom for five years, who still get pregnant on their own, for no clear reason. Of course, if they got pregnant after the doctor's "treatment", he is going to take all the credit. These anecdotal success stories bias the doctor, and his individual personal preferences are going to influence what he advises his patient. Some doctors are aggressive and will advise IVF for everyone, whereas others are much more conservative - and patients need to recognize this difference !

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

WhatsApp us at https://wa.me/919867441589/

The problem with IVF tests

A big problem with IVF is the uncertainty which surrounds it, because no one knows which cycle is going to work.

Patients have unrealistic expectations of IVF technology, and when the cycle fails, they demand scientific answers for why it failed !  And doctors compound the problem by running even more tests, in order to "diagnose" the cause of the failure.

However, the reality is that they're not able to do this because embryo implantation is a complex biological process, which we cannot control and we cannot monitor. After all, there is no way of being able to track the fate of a microscopic ball of cells once we put it back into the uterus !

The truth is that don't know which embryo will implant and which one won't - and we need to have the guts to share our ignorance and uncertainty with our patients.

However, IVF doctors are worried that if we tell the patient the truth , they will no longer respect us . This is why researchers manufacture a lot of very expensive , esoteric  and exotic tests , in order to demonstrate to the patient that we are trying to figure out exactly what the problem was !

However, the reality is we're just taking the patient for a ride ! When patients spend a lot of money, this is good for the doctor, but these tests don't provide any useful answers , because they are experimental and unproven.

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

WhatsApp us at https://wa.me/919867441589/

If you have only two embryos, should you transfer both of them ? or should you transfer one and freeze the other one?

If you have only two embryos, should you transfer both of them ? or should you transfer one and freeze the other one?

This is a common quandary for patients with a poor ovarian response !

If you have 2 top-quality blastocysts, what should your strategy be ? Should you transfer one and freeze the other ? Or transfer both together?

If you put both together, you increase your chance of getting pregnant in that cycle - but this is an unfair comparison - after all, you shouldn't compare apples to oranges !

You should compare transferring two embryos at one time , with transferring one embryo at a time in two consecutive cycles.

And the pregnancy rate with transferring a single embryo in two consecutive cycles - a sequential single embryo transfer ( SET) is actually better , because you need to add the chances of getting pregnant in two cycles.

The cumulative conception rate with two SETs is better that transferring two embryos in a single cycle.

The risk for the babies is also less, because you don't have to worry about the problem of preterm births because of a twin pregnancy

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/

Should you do a Day 3 or a Day 5 transfer if you only have a single embryo ?

Should you do a Day 3 or a Day 5 transfer if you only have a single embryo ?

 If you have lots of embryos, then it makes sense to grow them up to Day 5 ( blastocyst stage) because the embryologist can then select the ones which are growing the best , and transfer these, to maximise your chances of implantation.

Suppose you only have a single embryo on Day 3? Should you transfer on Day 3 ? Or should be willing to wait till day five? Now, this is a dilemma, because if you wait till Day 5 and it arrests in the lab, you'll have no embryos to transfer.  Many patients - and doctors - will say, "A bird in the hand is worth two in the bush," so we might as well put it back inside the uterus , even though the uterus may not be the best place for a Day 3 embryo. After all, why take a chance? And if it's going to implant, it may very well do that.

This is especially true for poor quality IVF clinics, which aren't very sure about their laboratory conditions, and don't want to take a risk . They want to transfer the embryo back into the uterus as quickly as possible , because this way they can tell the patient, "Well, we transferred an embryo , which means we did our best. And if it didn't implant, that's your bad luck."

However , if you have the courage, you should be willing to wait till Day 5. If it develops to a blastocyst in vitro, it has a better chance of implanting. And if it is going to arrest, I feel it's better it does so in the lab for the following reasons.

1. This spares you the agonising 2 week wait , and you don't have to live in unnecessary suspense and uncertainty. False hope can be cruel !

2. While this option causes short term pain, it helps you make more intelligent decisions about what to do in your future IVF cycles . Thus, it's easier to come to terms with the fact that you maybe better off using donor eggs, rather than trying IVF again and again with your own eggs.

What to find an IVF clinic which respects your time and intelligence ?
WhatsApp us at https://wa.me/919867441589/

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