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Should we do IVF for patients who have a poor chance of success ?

Posted Oct 04 2013 9:53pm

Infertile patients often come with unrealistic expectations about their chances of success with IVF treatment . As a doctor , I used to straightaway tell them NO, since I felt their chances were very poor and that the treatment would be futile . I was surprised when recently a patient with a high FSH level came to me for IVF treatment. I suggested she opt for donor eggs but she counter questioned me and asked if I was refusing to treat her. She was very clear that she didn’t want to try donor eggs. She said she could afford the IVF treatment and was intelligent enough to know that her chances were slim. She felt that her only hope left was IVF, and despite knowing that her chances were poor, she wanted to take a chance and try the treatment. Since there were no risks to IVF treatment, why was I refusing to listen to her  request. Wasn’t it unethical to say no to her, as this would be preventing her for exercising her right of making autonomous decisions for herself.

Seen in this light, this was a perfectly reasonable request from an intelligent and independent woman who had made her own decisions for herself all her life . She was very practical and down to earth.  Even if the treatment failed, it would help her in attaining emotional closure , because she would have peace of mind that she had tried every option available to her.

On her part, she just needed help from an IVF specialist and I couldn’t find a good reason to refuse to help her.  As a doctor I was pretty confident she wouldn’t grow any eggs and even if she did, her chances of getting pregnant were less than 1 % in my opinion.  My job was to be honest with her , and inform her about her chances of success so that she could make a well-informed decision after being aware of all her options. Despite knowing all the facts, if she then still wanted to continue with the treatment, I couldn’t justify saying no to her. However a colleague of mine was very critical about my decision. According to him, as a medical professional, I should decide if a patient’s request is reasonable , and if it wasn’t, I shouldn’t treat her , knowing her chances were poor.

What would you do if you were her doctor ?
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