IVF patients versus IVF doctors

When patients come to an IVF clinic, they expect to be treated by an IVF expert. Having spent many years in medical school, we have mastered technical skills such as egg collection and embryo transfer. However, some patients want only the doctor’s technical help , and not their professional advice. This includes carrying out laboratory procedures that the patients cannot do by themselves at home.

Such patients are normally familiar with the whole IVF process and may only want the doctor’s technical help. However, in such cases where patients are interested only in the doctor’s technical expertise , they may end up clashing with the doctor's professional views. For example, older women may insist that the doctor do IVF with their own eggs, instead of choosing egg donation , even when they know that their ovarian reserve is low and that their chances of getting pregnant are very slim. 

They do not want a doctor's advise - they have already made up their mind. They get upset when their doctor insists on offering them alternative options they are not emotionally prepared to explore.

If they do not accept the doctor's advise, he may feel that the patient is questioning his competence and authority and may consequently get annoyed.

The best approach is for both the patient and the doctor to agree on the kind of help the patient will be offered; whether technical or professional. Most importantly, patients should be open to diverse medical views as opposed to prematurely choosing only those options that seem appealing to them initially. They need to make well-informed decisions , based on a wide knowledge base. Equally, IVF doctors needs to be supportive and not judgmental - after all, patients and doctors are on the same side !

Your IVF cycle failed. What next?

Patients’ hopes are quickly dashed and pessimism sets in when their IVF cycle fails and they understandably turn to their doctors for an explanation. Some doctors will carry out a battery of tests in their endeavor to satisfy the patient that all will be well once all the tests are done. At times patients and doctors follow their instincts and patients are introduced to treatments such as immune therapy for treating abnormal NK cells or anti TB for a positive PCR.

The truth is that at times it is not possible to point out exactly what causes IVF cycle failure. Although there are a few exceptions such as when there is a thin uterine lining or poor ovarian response, the truth is that in most cases it is simply not possible to point out the exact cause.

The human reproductive system is dynamic and often surprises even experts. For example, embryo transfer can be a challenge due to excessive bleeding ; or a patient may have poor quality embryos , but she surprisingly gets pregnant , while a perfect IVF cycle with excellent embryos may fail. 

There is simply no doctor in the world that is able to determine the fate of embryos once they are transferred to the uterus.

What are your choices if your cycle fails ? You may choose to repeat the cycle if it was perfect - or you may want to change something. 

Possible things you can change include: 

donor sperm, 

donor egg, 

surrogacy, 

donor embryo, 

the superovulation protocol - or,

the doctor. 

Ultimately, the best way is to be prepared emotionally for failure . This will enable you to handle the emotional distress that follows IVF cycle failure. This also reduces unjustifiable complaints about doctors and clinics.

Why did my embryos not implant?

Patients want to know the reason(s) why their IVF cycle failed and the most common answer they get from doctors is “implantation failure”. However, patients should never get satisfied with such an answer because it is a meaningless term that could have numerous interpretation:

Did embryo development arrest in the uterus ?
Did the blastocyst fail to hatch from the zona ?
Did the endometrium fail to produce the right chemical signals to allow embryo attachment?
Was the uterine blood supply inadequate for nourishment ; or 

Was there a genetic problem with the embryo ?

The term “implantation failure” is just medical jargon - a wastepaper basket diagnosis, that does not explain the exact cause of failure of an IVF cycle. The reason for this is that today's medical technology is unable to determine what happens to an embryo upon its transfer to the uterus. At an IVF clinic, we are only able to study :

the quality of the embryo before we transfer it;

the ease of the transfer procedure ; and 

the uterine lining.

We cannot track its fate after we have transferred in into the uterus.

However, patients should not lose hope just because an IVF cycles fails. They should also not be misled into carrying out a large number of expensive tests that will only serve to cost them more money and time and lead to even more frustration , mismanagement and complaints. 

Instead, they must realise that the human reproductive system is dynamic ; and that the failure of the first IVF cycle does not mean subsequent cycles will also fail.

Managing an IVF patient’s expectations

Managing the high expectations of patients concerning the outcome of an IVF cycle is one of the hardest tasks that IVF specialists have to face. It is only natural for infertile patients to have high hopes of success after IVF and it’s only natural for doctors to be always optimistic and keep their patients’ hopes alive.

However, the problem arises when the outcome is negative and the patient feels cheated. This is normally the case when a doctor is overenthusiastic about IVF treatment and fails to clearly disclose to the patient the possibility of failure for fear of loosing out to doctors in other IVF clinics. This can be traced back to the fact that doctors are naturally confident in their work and they never want to appear doubtful about their job.

Good IVF specialists should be open with their patients and try to make them understand that there is always the possibility of failure regardless of the clinic they visit. The way forward would be for patients to arm themselves with information therapy ; and seek independent counseling to prepare them psychologically for all possible outcomes.

The guaranteed pregnancy option is another way of helping patients cope. It reduces complaints and information about the Malpani IVF clinic program can be found at http://www.drmalpani.com/guaranteedpregnancy.htm. 

IVF patients should stop viewing IVF as a single-cycle treatment, and understand that it can take them time to achieve their goal ; that patience and persistence pay off ; and that the reward is well worth the time and effort !

Patient complaints about IVF failure

Common patient complains about IVF treatment usually include : overcharging; running too many medical tests; not spending enough time with the patient; and not providing enough information.

In cases of IVF failure, patients can be quite vocal with their complaints because they feel they have been cheated. 

However, patients have a critical role to play in ensuring they get the best service delivery. 

Among the red flags that a patient must watch out for is failure by an IVF doctor to issue her with photos of embryos. This is because embryo photos are critical in ensuring the success of IVF. Consequently, when they come to Dr. Malpani for a second opinion concerning IVF failure, I will always remind them that it is their responsibility to demand photos of embryos.

That is not to say that I like criticizing my patients or talking ill of other doctors, but this is my way of empowering infertile patients to be proactive , and to seek as much information as they can , so as to clear any doubts about the quality of care they have received, so that they can get the best medical service. 

It is bad enough for any IVF doctor not to provide a patient with photos of embryo, but it is even worse for a patient not to be assertive and ensure she is given the photos!

However, if the doctor is not willing to share information with his patient, then the patient should look for another IVF specialist !