It is Best to Let IVF Patients Make Their Own Informed Decisions

A patient who had been advised IVF treatment found during her pre-IVF treatment workup that she had a five millimeter endometrial polyp in her uterus. Another IVF doctor she had gone to had advised her to get the polyp removed before getting her IVF treatment. This patient came to Malpani clinic for a second opinion from me.

In cases like this, it is hard to make definitive decisions. Each doctor has a subjective opinion of issues like this which fall in the grey areas of medical practice. Most doctors do believe in removing anything from the uterus before putting an embryo inside the endometrial cavity . Naturally, they suggested she get an operative hysteroscopy to get the polyp removed prior to the IVF cycle. This being a standard and logical approach , is usual medical advice.

On the other hand, many doctors consider this move unnecessary as there is no evidence that a small polyp affects embryo implantation. Since, there is insufficient clinical evidence for a concrete conclusion to be made, this issue remains controversial. IVF specialists tend to see only infertile women and they are quite likely to assume that if a woman has uterine polyps, that these are the cause of her infertility and will therefore, suggest their removal.  However, contrary to this belief, it is a fact that even fertile women can have endometrial polyps and can get pregnant even if these are left alone. Since, they don’t have a fertility problem in the first place , neither they nor the doctor ever discover it.

This leaves both the doctor and the patient in a state of confusion. The patient gets contradictory advice from different experts. One advocates surgery, the other advises her to leave the polyps alone. What is she to do?

Are you confused as well ?  Do you need an objective high quality second opinion from an IVF expert ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

The Commonest IVF Patients’ Complaints About Their Doctors

There is no patient who cannot recount horror stories about doctors. If you ever reveal yourself to be a doctor at a random party, be prepared to be regaled with endless complaints as to how terribly insensitive and uncaring doctors are these days. Apparently, their legendary family doctor was far superior  and everyone fondly remembers the caring doctor of yore, who made house calls and was a friend, philosopher and guide along with being a doctor !

That doctors do not share information with them is by far one of the most common complaints. This is a rightful complaint as doctors, being busy, do not share information with their patients unless they feel that the patient needs it. If the patient’s health is improving they feel that it is useless to burden them with information about their pathophysiology and differential diagnosis. But if the patient doesn’t get better, they will most likely have complaints against the doctor for not sharing all information with them. Assuming that he deliberately withheld information they imagine that the doctor is simply out to cheat them. But the fact is, he may simply have been too busy to reveal information to them.

It is a waste to make complaints that your doctor does not share information with you. You only become sulky, enraged, sad and bitter with your doctor being none the wiser about your resentment. Your doctor most probably thinks he has told you whatever you need to know.

Learning productive strategies to work as active partners instead of being passive recipients of treatment can be a wiser approach for patients. It is best to turn confrontational with the doctor only if the output is bad. Patients need to learn to be more assertive instead of being inert.

If you want more light shed on what information you need to maximize your chances of IVF success, please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

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 !