Friday, March 26, 2021

The best treatment for repeated IVF failure ( recurrent implantation failure) is TLC !

Some of the most frustrating problems in reproductive medicine today are the ones we do not have the technological tools to be able to make an accurate medical diagnosis for, We call them “idiopathic” – which is medical jargon for GOK - God Only Knows.

This is true for the three categories of the most difficult patients IVF specialists see today.

  1. Unexplained infertility , where all the medical tests we do aren’t able to explain why the couple can’t get pregnant in their own bedroom
  2. 2.   Recurrent implantation failure , or repeated IVF failure, where the patient fails to get pregnant in 3 IVF cycles, even though we have transferred top quality blastocysts in a receptive endometrium
  3. 3.  Recurrent pregnancy loss or recurrent abortion , where the patient gets pregnant , but loses the pregnancies every time , at about 6 to 8 weeks , and we not being able to pinpoint the cause.

Now we have a standard medical work up for all these conditions, which means we do an extensive  panel of tests to try come to a diagnosis. The problem is that usually we can’t find any abnormality !

This is the time when truthful doctors will stop, and confess to the patient that we have reached the limits of modern medical knowledge , and are now entering the realm of medical ignorance . Doing more tests will not help, and further testing should only be done by researchers who are doing controlled clinical trials. After all, it is not fair to treat patients in an IVF clinic as guinea pigs .

However, patients are not happy with this answer , and want more tests done – the more, the better ! Doctors are happy to oblige, because these tests are expensive, and very profitable for them to do. Also, doing tests conveys to the patients that they are being “thorough and careful”.

However, the truth is they provide no useful actionable information . What’s even worse is they are plagued by false positive results, which means doctors make patients waste a lot of time and money chasing red herrings.

Ideally, the doctor should be humble and honest,  and explain that there is nothing further medical science can offer them, and we have done everything humanly possible, which should give patients invaluable peace of mind that no stone has been left unturned. After all, medical science has its own limitations .

This doesn’t mean that we are helpless, and there is still hope for the patient – we aren’t writing them off or refusing to treat them.

Going forward, the two most important tools are – patience,  which means we keep on doing this until it works ; and the most important therapeutic ingredient is TLC,  or tender loving care !

This might sound surprising , because TLC doesn't seem to be a medical treatment which anyone could prescribe , but nevertheless it is one which has been proven to be extremely effective ! In fact , it's been shown to be far more effective for patients with recurrent pregnancy loss , as compared to additional experimental treatment options , such as PGT or immunotherapy . And the best thing about TLC is that it’s free !


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