A Sunday Column. IVF Treatment: Better, but not yet Good Enough

Feb 23 2014, 11:19am CST | by

On the occasion of the CDC’s yearly release of IVF clinic success rates, I remind myself and my old colleagues that we should always strive to do better.

Every baby, whether conceived by in vitro fertilization or dropped by a stork down the chimney, is a miracle. 

As a reproductive endocrinologist, I had a unique opportunity to make small contributions to some of these miracles. But as I constantly reminded myself and my colleagues: the miracles are the babies, not the procedures.

That is still true today. Assisted reproduction as it exists in the year 2014 is still a pretty primitive set of procedures and tools.

We blast away at the eggs remaining in the ovaries with hormone levels far higher than nature ever intended. We pull the eggs out of the ovaries at warp speed and place the eggs into a laboratory that, no matter how advanced, is still a more hostile environment than the one nature designed. In some cases we fertilize enough eggs to fill a school classroom and then we take often more than the ideal number of the absolute best developing embryos and transfer them back into the uterus — where in the best of circumstances one will turn into a baby about half the time. Put this way, the “miracle” may not be so much the result that we achieve as the fact that we are allowed to charge for the process. Maybe I overstate this, but I do think that we should hold off on applying for “miracle maker” status until we’re somewhere close to a 100% pregnancy rate putting back one embryo at a time.

I dislike the way the term “miracle” (as in “miracle baby” or “miracle procedure”) is used. The term can be harmful.

It can be harmful to patients’ abilities to cope with the already significant stress of an in vitro fertilization cycle. 

What happens when a cycle fails and a patient thinks,  ”Maybe I don’t deserve the miracle?”

If a patient believes that the outcome of an IVF cycle is a miracle, and is therefore not based in very real and very limiting probabilities, then she is going to very naturally feel that the outcome will reflect whether she is worthy of such a miracle or not.

The truth is, when IVF fails a patient, IVF has failed. Not the patient.

If every patient at the IVF starting line feels that he or she is as equally deserving of a miracle as the next person, then they’re going into their IVF cycle with much more on the line than the obviously very important things that the outcome will or will not bring. How many women have I had say to me that “anything bad that can happen in their treatment and their attempts to get pregnant will happen to me.”As much as I hate to even bring up some of the more sobering statistics about IVF outcomes, or to point out to a couple that their prognosis may be somewhat worse than many of the other couples we see, doing so is a hedge against the very real risks that they’re putting not only their future family structure but also their very self-image on the line. This is far too much pressure for any couple to have to bear.

The second insidious effect of allowing ourselves and our patients to think that the outcomes of procedures are miracles, is that we are suddenly shifting the blame from the outcome of a negative cycle from ourselves as doctors and scientists and from our procedures —  to the patients themselves. Self blame is never far away from assisted reproduction. Unspoken or not, many people feel they are being punished for something in their past and the punishment is their infertility. In this setting, some are all too ready to unfairly blame themselves for the bad outcome of a cycle in which the pregnancy test is negative.

 As doctors we can unwittingly feed right into this. Look at some of the dictates and rules sometimes set on IVF cycles, often with no more backing than “it seems like a good idea.”

Rule number one: stay in bed or stay on bed rest for many hours or even days after the embryo transfer.

Rule number two: no intercourse during the IVF cycle.

Rule number three: no exercise during the IVF cycle.

There is little or no evidence that any of these things is actually true. I actually had women ask me, in states of panic after having had an orgasm sometime between their embryo transfer and the pregnancy test, whether they had ruined the outcome of their IVF procedure. Someone somewhere had told them that any type of sexual arousal would have a negative effect on their IVF cycle.

What complete crap!

The fact is that the uterus, and its ability to protect early embryos in their development, is one of the biggest assets we have in assisted reproduction.

While it is completely understandable for patients to seek reasons and even get superstitious over the outcome of an IVF cycle, it should be the job of physicians and medical professionals to go out of our way with reassurance that the reason IVF cycles don’t work when they don’t work is because of the limitations of the procedure itself and not because of some extraneous factor that just allows us to shift the blame over to the patient or couple.

The field of assisted reproduction has made taken some wonderful strides over the decades. We don’t need to artificially inflate what we’ve done, nor do we need to diminish the role and the importance of the patients themselves. So let’s leave off all the talk about miracles, except when we’re talking about the babies themselves.

Babies who are born because of, in spite of, or independent of anything else that IVF may do.

Source: Forbes Business

 
 

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