Saturday, April 09, 2022

What are my chances of IVF success ?


One of the commonest questions every IVF patient asks at the time of a consultation is - Doctor, what are my chances of success ? This seems to be a very simple question , and one would expect that IVF doctors should be able to answer this easily – after all, we are medical specialists , with years of experience and expertise !

However, the reality is we can't answer this question, and the truthful answer is – No one knows . Unfortunately , this is not the answer which patients want to hear , and because doctors are smart , rather than be honest and tell them that no one in the world can answer this question accurately, most IVF specialists are happy to put a positive spin on the number and promise them the earth and the moon in the hope that they will sign up for IVF treatment in their clinic. This is why so many Indian IVF clinic websites claim exaggerated success rates of 80% and more !

The reason for our ignorance is because we cannot predict the chances of success for an individual patient in an individual cycle – after all, doctors aren’t fortune tellers, and the law of small numbers makes prediction impossible,

This is because embryo implantation is one of those biological variables over which we don't have any control - and if we can't control something , how can we predict what's going to happen ?

The trouble is most patients aren’t mature enough to accept this reality , and badger the doctor to provide some kind of a number . Doctors are very happy to pull a number out of a hat – and they know that the higher the number they quote , the happier the patient will be – at least for now !

The trust is this percentage ( and some doctors are happy to say it’s 90% !) is a meaningless number ! While clinics can provide a base rate – the probability of success in a group of women with a medical history similar to yours - the reality is that you don't care what happens to the 99 other women in the clinic - you only care about what happens to you !

This is why an “ 80% success rate “ is meaningless for an individual patient , because your outcome is going to be binary - it's either going to be 100% , or 0%. Sadly, most patients are innumerate, and don’t understand that statistics can be applied to populations , and not to individuals .

Unfortunately , doctors don't bother to explain this , and are quite happy to provide the patient with false hope and sweet talk them into signing up by quoting any number they want.

The harm this causes is that patients then have very unrealistic expectations of success , and then when their IVF fails, they go to pieces , and cannot gather the courage to try another cycle , so the false short-term hope causes long-term pain !

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