Monday, May 24, 2021


One of IVF’s dirty little secrets is that the amount of stuff we don't know about IVF is far more than what we do know. For example, we are still not able to predict which embryo will implant; or why top quality blastocysts  do not implant ; or which eggs will fertilise; or which embryos will develop into blastocysts.

Most IVF doctors are quite happy to conceal this ignorance , and this is why patients overestimate how much we can control during an IVF treatment cycle.

There is tons of stuff we don't know much about – and we conveniently label this as “unexplained”, to hide our cluelessness, because once we put a name on the problem, we feel more in control – even though the name is meaningless, and is virtually a waste-paper basket diagnosis.

Because so much remains unidentifiable , undiagnosed and untreatable , we continue to use empirical therapy extensively in IVF.

Empirical therapy covers many interventions, such as using vitamin D to improve ovarian reserve ; and treating patients with low-dose aspirin after the transfer based on the fact that its anti-platelet activity may improve uterine blood flow.

As long as these “treatments” are low cost and low risk , I am comfortable prescribing them. However, doctors love prescribing the “newest, latest and most expensive” therapy which happens to be the fashion of the month ! There seems to be no limit as to what they will prescribe under the guise of empirical therapy . This includes stuff like IVF intralipids; low molecular weight heparin ( LMWH); intravenous immunoglobulins ; and paternal lymphocyte immunization therapy ( LIT).

The truth is no one knows whether any of these things work or not , even if doctors prescribe them confidently, based on their “extensive personal clinical experience” !

I think that's fine , but in all fairness , doctor should share this uncertainty with their patients, before actually prescribing unproven therapy . The sad reality is doctors will not do this , because they just want patients will behave like dummies who will obey orders mindlessly , and not question the doctors as to whether there is any scientific basis behind what they are advising.

Dumb doctors love dumb patients , and dumb patients deserve dumb doctors !


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