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Why are there so many "treatments" for failed embryo implantation ?

Posted Apr 21 2013 10:34pm

As an IVF specialist , one of the commonest questions patients ask me is - Why did my IVF cycle fail ? This is a perfectly valid question , and I can understand why patients want an answer. After all, once we knew what the problem was , it's quite logical that we would be able to find a solution for it ! However, the sad truth is that our technology has limitations and it's not possible for us to answer the question as to why an individual IVF cycle fails. After all , when you transfer a microscopic ball of cells inside the uterine cavity , it’s impossible to determine its fate and to find out exactly why the embryo did not become a baby ! Did the embryo arrest (stop dividing ) ? Or did it fail to implant because there was not enough endometrial blood flow ? Unfortunately, when we can't answer these questions , patients get frustrated and upset .

The right answer is - We don't know ! However , when you tell patients the truth, they get upset, because they feel that if you don't know what the problem is, how will you ever find a solution for this ? They start getting extremely pessimistic – and even worse , they start doubting the doctor’s competence ! They
feel ( but rarely express loudly !) – If this doctor cannot even provide answers to these basic questions, how will he ever be able to get me pregnant ? They therefore start looking for second opinions and start doubting the doctor’s ability ! ( This is truly ironic, because only a very confident competent doctor has the courage to say – I do not know . However, few patients have the maturity to appreciate this forthrightness !) This is often why many doctors ( because they are under pressure to come up with answers), rather than being upfront with their patients and telling  them the truth , will start doing exotic and expensive tests , and coming up with fanciful answers such as “ immunological rejection of the embryo “ to keep their patients happy.

We all know that a lot of these patients will get pregnant in their second IVF cycle, even if they repeat exactly the same treatment protocol which they did for their first cycle ( and we will never know why the second cycle worked or why the first cycle failed !) Of course, if the doctor does make a change ( for example, he adds “ new treatments” such as intravenous immunoglobulins ( IVIg) or low molecular weight heparin ( LMWH), the patient is happy to give credit to this intervention for the success !

This is one of the reasons why there are so many myths and misconceptions about what can be done to increase the chances of embryo implantation. This flawed reasoning causes a lot of confusion. For example, if the patient has done one IVF cycle which failed, and then the doctor does a second cycle after giving IVIg, and she then gets pregnant in the second cycle , the doctor logically jumps to the incorrect conclusion that it was the IVIg which converted the failure to a success . He starts swearing by IVIg; starts presenting his results at medical conferences; and starts putting all his patients on IVIg, without ever scientifically analyzing whether the IVIg actually had anything to do with the success !

This is why the field of failed embryo implantation is full of myths, misconceptions and half truths , and lots of doctors and patients are confused. The trouble is that unless patients have the maturity to understand that doctors don't have all the answers, this vicious cycle will continue. Of course, the “answer” will change from decade to decade, depending upon what seems to be the molecule in fashion at that particular time .

The bottom line is that the quality of the doctors answers depend upon the quality of the patient's questions . Unsophisticated , poorly informed patients ask poor quality questions , which end up compromising their medical care . Conversely, patients who invest in information therapy ask intelligent questions , thus ensuring they are satisfied and happy with the quality of medical care they receive.

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