Monday, 21 April 2014

Why do some doctors prescribe so many tests after a failed IVF cycle?

Before undergoing IVF, the infertile couples are explained about the prospects of the treatment, with a clear picture about the chances of success and failure. However, after undergoing the process, patients sometimes become more emotional than rational. 

Now, when a doctor informs that the cure of infertility might be IVF then failure of the IVF cycle puts a pressure on the doctor to give the elaborate explanation for the same. To avert the blame game, few doctors prescribe a panel of expensive tests following an IVF cycle failure. Reason, obvious to find out the cause of failure.

Actually, the reasons of failure can be multiple and it is not possible for doctors to find the exact one. Sometimes, under the pressure mounted by patients few doctors run a list of tests to uncover the reasons. Wanting to be provided with best and logical answers, patients are in continuous efforts to question the doctor. 

It is obvious because undergoing IVF through emotional and financial pressure is something not everyone can afford. Understanding from the doctor’s point of view, IVF is performing a natural process outside the body. What is performed in the laboratory (formation of embryo) is within the control of doctors but after implantation not even doctors can have control over a natural process. It depends on how our body reacts to a particular external procedure.

Running a panel of tests might sound logical but actually would be a complete futile effort to justify the IVF cycle failure. Again the reason is these tests provide very less useful information. There is no particular test to check why the cycle failed. There are few related tests that might be like running round the bush but not giving the exact information. Reacting to the pressure mounted by patients, doctors perform these tests to satisfy their patients.

If a doctor tells them that he does not know why the cycle actually failed then it might endanger the reputation of the doctor. So, the best way to control the damage is leave the answers to the tests. Test results (cryptic in medical terminologies) might serve the answers to the queries of patients.

Doctors would want every IVF cycle to succeed and if it would have been possible to predict the reason behind the failure then the subsequent patients undergoing IVF would never have to face the failure. If these tests would have provided the information then doctors would have performed it before the IVF. Generally, the doctor would recommend immunological tests, tests for endometrial function, and sperm DNA fragmentation tests but these tests are expensive and not useful.

Now, the patient would want to know that if these tests are futile then what is the solution? The only solution is proper counseling of patients and having realistic expectations. So, when the first cycle fails, the patients would be able to translate the reasons for failure without unnecessary tests. A well-informed patient would then realize that embryo implantation is a biological process over which we have very little control and so it is impossible to control the embryos once it is transferred. 

At Pahlajani IVF Clinic, the patients are counseled about the foreground and background of the IVF to give a crystal clear image about the actual process to patients.

Dr Neeraj Pahlajani

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