When IVF doctors err

Being human, it is inevitable that IVF doctors also make mistakes. I made a mistake too, not long back. While consulting a new patient at Malpani Clinic recently, I accidentally put down her age as 41 instead of 31. The problem was that owing to my miscalculation, I had put her in a category beyond the crucial age of 35. Since, age is a major determinant for infertility treatment, I advised her to consider IVF treatment.

At the end of the consultation. I have the habit of making reviews of my own advice and records with my patients to ensure that they have completely understood what I have to say. With this patient, I started off by saying, “Given the fact that you are 41, I think you need IVF”. I was interrupted by her with the embarrassing revelation that her age was only 31 and not 41! I was highly mortified with this very basic mistake of mine , and I quickly apologized. I made corrections and consulted her afresh after reviewing my advice. Needless to say, the patient was visibly upset with this episode and very understandably so. For someone who wasn’t that weak in making simple mathematical calculations, it was a shameful mistake. The patient might very well have felt that an error in doing something as simple as calculating her age could reflect my incompetence as a doctor.  She might even speculate as to what other mistakes I might make in the future. Chances are, she might decide against coming to me for treatment.

Then again, when I encounter mistakes made by other professionals, I am open towards viewing things from a more lenient perspective. I am willing to be forgiving of them because I have made y own share of errors. 

Do you think your IVF doctor has erred in your treatment ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

How to make sense of your IVF doctor’s advice

Infertility specialists are sought after by patients for their tremendous technical expertise. Infertility doctors master technical skills like egg collections and embryo transfers over several years in medical school. Our patients at Malpani Fertility Clinic have come to us not only for our technical prowess but also for our professional opinion. Rightly so, as medical professionals like infertility specialists can properly suggest possible treatment options and advise them on their best course of action.

Although a significant number do expect guidance from the doctor, this is not true of all infertile couples. These couples have a course of action in mind and simply want the doctor to implement their plan as a technician. They want the doctor to carry out assisted reproductive procedures for them in the laboratory as they cannot do it themselves in their own bedroom. For their purpose, a doctor is merely a trained technician than a professional.

Because they know their own minds, this makes them an easy group of patients to deal with , as they do not require much counseling. For them the IVF clinic simply has to carry out their treatment plan. Older women with poor ovarian reserve comprise many of these patients. They are unwilling to consider egg donation or adoption and therefore want the doctor to perform IVF for them, even while knowing fully well that with their depleted ovarian reserve, their chances for success are pretty low. http://blog.drmalpani.com/2012/12/should-patients-follow-their-doctors.html

The reasons behind IVF failures

Even the perfect IVF cycle does not guarantee a pregnancy despite the best efforts of the best IVF doctor. The failure of an IVF cycle can be highly depressing for both doctors and patients. IVF doctors get baffled at why the IVF cycle failed and their competence gets questioned. They try to figure out whether there were other factors involved. Patients with complaints of repeated IVF failures even consider switching clinics as they are emotionally susceptible and need solutions immediately. They woes at the inability to conceive even when seemingly perfect embryos were transferred translates into frustration and extreme distress.

A successful pregnancy by IVF is determined by just two factors: the quality of the embryo created by the doctor in the IVF laboratory and the uterus of the recipient. A top quality embryo is logically expected to develop into a baby in a receptive endometrium, putting the theoretical success rate of IVF at a hundred percent. But the most baffling fact is that even the best embryos in a receptive uterus sometimes, do not implant. This unknown realm depicts the presence of yet another factor. To learn more about this X-Factor in IVF treatment see http://blog.drmalpani.com/2012/09/the-x-factor-in-ivf.html

Is there hope after several failed IVF cycles?

It is a challenge for IVF specialists to deal with patients with recurrent implantation failures. These patients, also labeled as having repeated IVF failures, have undergone numerous IVF cycles without getting pregnant yet. The reasons for the staggering amount of IVF or implantations failures for these women are still unknown.

At Malpani Fertility Clinic, we theorize the reasons for such failures to either be the poor quality of embryos or problems with endometrial reception.

Since the exact reason for IVF failures cannot be pinned down for a particular patient, the treatment options for these patients are in a cloudy scenario. Run down by repeated failures, these patients are highly strung and desperate for a pregnancy. This results in them going to various doctors, with each new doctor offering a new solution of his own to the problem. The range of treatment options thus suggested include intravenous intralipids, PCG for comprehensive chromosomal screening, immunotherapy to treat natural killer (NK) cells and so on.  Find out more about the treatment options after multiple IVF failures at http://blog.drmalpani.com/2012/09/the-best-treatment-option-for-patients.html

Can PGD improve the chances of a successful IVF?

While making embryos in the IVF lab at Malpani Fertility Clinic, we aim at transferring a single embryo of a good quality to the recipient’s uterus which may then implant and develop into a healthy baby. However, our expertise at pinpointing which embryo will develop into a baby is limited. We evaluate embryo quality based on their microscopic appearance. Features such as any fragments of the embryo, the equality of the cells, the cell division rate etc. are examined.  Malpani Fertility Clinic then singles out the embryo that appears best and performs the transfer with this top quality embryo. But even this embryo is likely to be genetically abnormal as its appearance cannot guarantee a normal chromosomal make up.

To solve this problem, Malpani Fertilty Clinic carries out Preimplantation Genetic Diagnosis (PGD). The embryo is biopsied and a few cells removed. We check the chromosome copy number of these cells using Comprehensive Chromosome Screening (CCS) . This technique has great potential as it allows us to select genetically normal embryos. It can improve IVF success rates as they have better odds for implantation than genetically abnormal embryos. Learn more about PGD at http://blog.drmalpani.com/2012/09/should-we-be-doing-pgd-for-everyone.html