Dealing with the failure of an cycle can be one of the hardest things that an infertile couple has to go through. One of the unexpressed concerns which the wife often has is – Was I responsible for the failed IVF cycle? Did I do something wrong which caused the cycle to fail? Was it because I lifted a bucket or sneezed after the transfer, which caused my beautiful embryos to fall out of my uterus? Is there something wrong with my body? Is my uterus rejecting my embryos? Is my immune system out of whack? Is my body too hot? Or am I too fat?
These are all concerns that a lot of times patients do not get satisfactory replies to.
Many patients don’t dare to ask these questions because they feel they are stupid. They do not want to irritate the doctor by asking them such silly doubts, which is why they often bottle them up. Even worse, they look for answers from friends and relatives (most of whom are as badly informed as they are, which is why there are so many old wife’s tales about embryo implantation). Some will go online and scour bulletin boards and forums for answers. Sadly, most of they are cluttered with information, which cannot be trusted and is often wrong.
While it’s easy to understand why the patient’s mind is playing games, the tragedy is that many doctors are also partly to blame. The truth is that often we don't know why the cycle failed. However, few doctors have the courage to be able to tell patients this upfront. Often, they over promised success when starting the cycle or when doing the embryo transfer. They now need to manufacture an answer to save face, and the easiest thing to do is to blame the patient!
Also, doctors know that patients expect them to be omniscient. They are worried that patients will lose confidence in them if they answer honestly, which is why they cook up answers, some of which are full of scientific gobbledygook (such as – Your high NK cell levels killed the embryos, so we will treat you with immune therapy to improve your chances of success in your next cycle). This is a sophisticated form of victim blaming in my opinion. If the doctor truly believed that high NK cells could cause embryo rejection, then why not test for this before starting the cycle? Why wait till the cycle fails?
Many doctors get defensive. Their approach is – We did everything perfectly, because we are such a good clinic. Most of the other patients in your batch got pregnant (something which can be hard to verify!). The reason you failed because you didn't follow instructions!
This just ends up making a bad situation even worse. Not only do patients have to deal with having to cope with the failed cycle, they now also had to deal with the additional burden of guilt that they may have caused the cycle to fail.
This is when information therapy can be extremely valuable. Patients need to invest in this, before they start the IVF cycle, so they can accept the reality that there is nothing the patient can do to either increase or decrease the chances of embryo implantation. Once the embryo has been transferred, it has to follow a natural biological process, which neither the doctor nor the patient can control.
Dr. Aniruddha Malpani is an IVF specialist with a brilliant career with numerous awards, educational distinctions and prizes. Dr. Malpani completed his postgraduate degree in Gynecology from the University of Bombay in 1986. He received further training in IVF from UCSF, San Francisco, and U.S.A. As a medical student, he studied at Harvard, Johns Hopkins and Yale. He practices in Mumbai, India along with his wife Anjali. He can be contacted at email@example.com, or learn more at http://www.drmalpani.com.