IVF treatment involves a series of steps, which include: superovulation ( giving the woman hormones to help her grow many eggs); egg retrieval ( where eggs are collected from the mature follicles under ultrasound guidance by aspirating them) ; fertilization ( which occurs in vitro, or “in glass”, where the sperm fertilise the eggs in the IVF lab to create an embryo) ; and finally, embryo transfer.
Most of these steps are under our control , which means it’s fairly easy and straightforward for a good IVF clinic to do them properly . Think of these as a series of hurdles we need to cross in order to get to the stage of embryo transfer . However , after making the embryo , we need to transfer it back into the uterus , and we come to the final step of the IVF cycle over which we have no control whatsoever – that of embryo implantation. This is still a black box area , and once we put the embryos back in the uterus, we cannot predict or control or monitor what’s happening to them. This is hardly surprising, because being able to track the fact of a microscopic ball of cells inside the uterine cavity is not something which our technology is capable of as yet.
Most failed IVF cycles fail because the embryos fail to implant, and this is called failed implantation. This has become the commonest reason doctors use for explaining to a patient why their IVF cycle failed . It conveniently absolves them of all responsibility , because embryo implantation is not something that is in the doctor’s control .
The fact of the matter is that the reason why most embryos fail to implant is because they are poor quality embryos; and the biggest tragedy is that the commonest reason for poor quality embryos is a poor quality IVF clinic . Now this is not something which most patients understand , and no IVF doctor is ever going to acknowledge this openly , even when they their IVF laboratory is sub-standard.
Most don’t have the experience or expertise needed to run an IVF lab well, but it’s easy to hide this truth, because what happens in the IVF lab is hidden from the patient, and doctors take advantage of the patient’s ignorance. Every IVF clinic claims it is the best, and that they have the world’s best technology, and that they follow global best practices , but the reality is that they hide information from patients. This can be easily confirmed by the fact that most of these IVF clinics refuse to share photographs of embryos with their patients , and the reason they do this is because they aren’t willing to be open and transparent . They know they have created poor quality embryos , because they run a poor quality lab , but they also know that if they share this information with patients , they will end up going bankrupt , because no patient will ever be willing to come to them for treatment . This is why they lie to their patients.
The tragedy is that it’s very easy to cheat patients , because Indian patients are very trusting , and they believe that all doctors are equally competent and honest. Unfortunately , this is not true , and most patients only learn this the hard way , after they have failed a cycle, and sought out a second opinion.
The good news is that it’s possible to analyse an IVF cycle after it fails by carefully and critically looking through your medical records. This is why it is so important that you get photographs of your eggs and embryos, so you can confirm that the IVF lab is technically competent, and has created good quality embryos for you.
Good IVF clinics routinely and proactively provide embryo photos to all their patients , so that they can prove that they have provided good quality medical care , because they can never predict in advance which cycle is going to fail and which one is going to succeed .
If this information is missing , this is a red flag, and means that you will never be able to determine what the reason for the failed implantation was.
Doctors will be happy to blame your sperm or your eggs or your genetics or your immune system for the failed implantation, because they want to pass the buck to you, and they refuse to accept the responsibility for the failure . This is truly tragic , because once patients have lost confidence in one IVF doctor , they lose faith in all IVF doctors , and will refuse to take treatment in any other clinic , because they have already burned their fingers once.
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