Whenever an IVF cycle fails, the first question patients ask is – Why did it fail ? and the second is – What can we do differently the next time?
IVF patients need to understand the difference between process and outcome, and just because the cycle failed doesn’t mean that the process was wrong , or that anything needs to be changed in the next cycle. The problem is patients demand that something different be done in the next attempt, so I ask them – Why do you want to change something ? After all, if the cycle has gone perfectly, there’s no advantage to changing anything.
The problem is their misconception that the cycle failed because something must have gone wrong ! So, why can’t we figure out what went wrong and why can’t we change this? Yes, this sounds logical, but the human body is not a car which can be taken apart !
We are very good at making good quality embryos when we do IVF, and we can document this by providing photos of your embryos, but after we’ve transferred the embryo back into the uterus, the truth is that embryo implantation is still a black box area , and we do not know why some embryos implant and we do not know why some embryos do not implant . Because we cannot identify the problem, we can’t solve it, and we need to accept this truth in all humility, rather than manufacture answers just to placate the patient.
There’s stuff we can control in an IVF cycle – and lots we can’t. And just doing more tests ( for example, PGT or ERA) doesn’t really help the patient. Yes, it’s great for the doctor , who can earn more money by doing these tests, but it’s not great for the patient because it doesn’t increase success rates. I always tell patients that instead of asking why didn’t the cycle work, they should ask – Why did it not work so far ? And just because it has not worked so far doesn’t mean it’s not going to work in the next cycle either !
The best analogy I can give is comparing IVF with baby-making sex in the bedroom. Just because a couple have been having sex in the bedroom for six months and haven’t got pregnant, they don’t no one change their spouse ! They know they need to be patient because human reproduction is not efficient and that it takes time to make a baby !
Yes,it’s much more fun being patient in the bedroom , and it’s much harder when you’re spending so much money during the IVF treatment, but the biological final common pathway – embryo implantation – remains the same, whether it’s IVF , or whether it’s sex in the bedroom.
There is logical basis for making a change, and the emotional desire to change something ( anything !) makes very little sense. But because patients start becoming desperate and want the doctor to do something different or new, doctors will oblige them, but this is definitely not in the patient’s best interest. The only way to protect yourself from unnecessary over-testing and over-treatment is to be well-informed, and you should invest in information therapy before your start your cycle so you don’t panic in case it fails . And we always tell patients that the more you know, the lesser your anxiety levels will be , and the easier it will be for you to cope with the ups and downs of the IVF cycle.
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