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.

What went wrong? Why did the IVF cycle fail?

In cases of failure of an IVF cycle, patients are naturally curious to know what might have caused the failure. However, this is where some IVF doctors go wrong. They interpret the patients’ inquiry into what might have gone wrong to mean that the patient is casting aspersions on their competence. They therefore resort to carrying out numerous medical tests in their endeavor to leave the patients satisfied that the doctor is trying to get to the bottom of the matter and a solution will soon be found. This is a sad fallacy.

Doctors order tests knowing full well that medical technology has its own shortcomings and that it is not always possible to ascertain the true cause of IVF cycle failure. A mature doctor should be able to face a patient and honestly explain to her that there is no technology in place that determines what happens to the embryo while inside the uterus after having been transferred.

Conversely, patients should be well-informed and be willing to listen to the truth that even in a perfect cycle , the chances of success are always less than 50% . This would help reduce numerous complaints about IVF doctors;  and save the patient’s time and money spent visiting IVF clinics in order to do expensive and unnecessary tests.

The second IVF baby

Upon having their first child via IVF, most infertile couples are understandably relieved and are filled with so much happiness that they feel their family is complete. They find their first child completely fulfilling, and do not even dream of having another baby.

However, about five or six years later, the very couple that successfully had their first child via IVF will walk into a clinic and give IVF another try, this time more enthusiastic and confident of their chances of success. Mostly, they explain that their first child is lonely and needs company.

Such patients need to understand that as much as their chances of their second IVF succeeding are normally high following the success of the first cycle, it does not mean that the second cycle has a 100% chance of succeeding. Dr. Malpani says the best approach would be to always plan for the future just after the successful completion of the first cycle by asking your IVF doctor to safely store the frozen embryos for you if you had arranged for them to be frozen. Those embryos are from the cohort that succeeded during the first cycle and therefore their chances of getting you a baby are high.

The most encouraging element of the IVF cycle however is that you will have established a good rapport with your doctor and you will know how to get him/her to adequately respond to your complaints and questions. Moreover, you will have lots of IVF knowledge carried over from the previous experience.