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 good IVF doctors do only IVF (and nothing else)

While every IVF specialist is equipped with the requisite knowledge in gynecology and obstetrics, IVF is a very specialized branch and that is why IVF specialists worldwide should stick to doing only IVF and not try to multitask by doing hysterectomies and caesarean sections in order to increase their income.

Most IVF specialists the world over have dedicated their time, resource and energy to practising only IVF - this is a full-time job ! However, most Indian IVF clinics are run by general gynecologists. This implies that they practice IVF only on a part-time basis alongside with offering a host of other gynecological treatments. The end result is sub-standard IVF services to patients, mostly ending up in low success rates. IVF patients should therefore go for specialists who have dedicated all their time and energy in doing IVF because this means that they are passionate and confident in what they do without the fear of having high rates of failure and running out of patients.

Moreover, such dedicated IVF specialists have spent a lot of time in honing their skills and will offer personalized treatment, never leaving their patients complaining about being left in the hands of doctor’s assistants as they travel abroad in search of more money from other patients. Patients should therefore review their options before they choose an IVF doctor instead of airing complaints about having been heated because they failed to do their homework in searching for competent IVF specialists. 

IVF failure stories

The large majority of IVF websites are filled with IVF success stories ; typically first hand account of patients who share their happy experiences with the world after having successfully become pregnant via IVF. Such testimonies are very important because they give hope to other couples who were not blessed with a child and are exploring their options. However, of equal importance are IVF failure stories, which most IVF websites never post for patients.

Such stories would enable patients who were not lucky to have a baby via IVF to cope with their status and more importantly equip them with appropriate knowledge and skills to deal with such occurrences.   It is also worth noting that patients who were never lucky with IVF are never willing to share their stories because they see themselves as failures whose dreams of having a baby have been shattered. It is therefore important that such patients realize that with IVF, the chances of success are never 100% and that the failure of an IVF cycle does not mean the end of the world and that you will never have a child.

The problem is that most clinics fear publishing IVF failure stories . They are worried that this would discourage patients and drive them away to their competitors. I, Dr. Malpani beg to differ. I believe that most patients are smart enough to face the truth and a clinic that publishes IVF failure stories would command a lot of respect - unlike those that only paint a rosy picture about the process, only for patients who fail to be disappointed and then express lots of complaints and write negative reviews about the IVF clinic.

We all learn from experiences - and both IVF failure stories and IVF success stories have a lot to  teach us !

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.

A national chain of branded IVF clinics in India

The inefficiencies in the Indian health sector are increasingly attracting venture capitalists (VCs) to invest in this space IVF in particular looks very attractive and many VCs have put their money in it. However, with most of those investments modeled in the form of a national IVF chains, most investors have had to close their chains because of the failure of their management and operations structure.

The problem is that most VCs have taken advantage of the comparatively lower cost of setting up an IVF clinic to set up a large chain of clinics without putting in place a well-defined mechanism to manage their operations in such a way that they are efficient and synchronized. An IVF chain is bound to fail if the success rates of pregnancies in individual clinics have wide variations and if they lack a single head doctor to play a policing role in monitoring the operations of the chains to ensure they are streamlined.

The failure of some of the branches of these IVF clinics to help patients achieve pregnancy is likely to damage their reputation. Patients will feel cheated and will write negative reviews online about their experience in these IVF clinics. Moreover, an IVF chain is bound to collapse if it lacks dedicated IVF specialists whose sole responsibility is to handle IVF patients as opposed to handling all manner of gynecological cases such as endoscopy and hysterectomy in attempting to maximize their income.

 
Very  busy clinics will try to improve their profitability by treating as many patients as possible. However, once they cross  the optimal level of 1000 cycles per year , they will fail to offer personalized patient care. They are likely to experience a huge numbers of patient complaints and therefore lose their patients to their competitors. 

At Malpani Infertility Clinic, as a refreshing contrast,  we offer  very hands on personalised care to our patients.  We are a boutique clinic, which pampers its patients !