Common Fertility Treatment Mistakes and How to Avoid Them

Ms. Elizabeth Paul (not her real name) was my last appointment of the day, and she brought a thick medical file that described all the medical tests and treatments she had been through. She had consulted doctors on three continents, and was now seeking another medical opinion for her problem of unexplained infertility. She had had four laparoscopies, performed by various doctors in different parts of the world - and had been through six insemination treatment cycles.

She now wanted me to do another insemination for her. When I advised her that it was time to consider IVF, she got upset. - Why do I need IVF when all my test results are normal, doctor? Can't we just do another IUI cycle please? -

This is typical of many patients I see. They change multiple doctors, but each new doctor ends up doing exactly the same thing the previous doctor did. When I ask why they give permission for their third laparoscopy, the typical answer is, - My new doctor did not trust the previous doctors reports and needed to see for himself. - Hope springs eternal in the human breast, but patients get so fed-up and frustrated going through the same cycle month after month that by the time they come to my clinic, they are ready to give up.

As an infertility specialist, I find the saddest stories are those of patients who failed to get pregnant because they did not get the right medical care. Being infertile is bad enough, but having a problem that is not treated correctly is even worse. Instead of wasting her time and money on repeated laparoscopies and IUI, it would have been much more cost effective for her to have moved on to IVF.

What can you do make sure you donît get sub-optimal care? Here are the common mistakes I have seen infertile patients often make, and you need to learn to guard against these.

-We'll Take Care of it Later°

Since infertility is never an urgent problem, many couples keep on putting-off seeking medical attention. There is always something more pressing, and who likes going to a doctor anyway? Many will refuse to go, because they'd rather not acknowledge there might be a fertility problem.

Refusal to Consider Alternative Treatment Options
This is a common mind-block, especially among men. Many of them believe that treatment is -unnatural° or artificial, and they would rather have a baby who was conceived in the bedroom. Itîs better to be aware of all your options up front, and to explore these systematically, rather than try a hit-and-miss approach.

Getting Fed-up and Giving Up

Infertility is likely to be one of the first major life crises you will encounter, when you have to confront your biological frailty. Moreover, itîs a problem that will not go away by throwing money at it, since the technology is still not perfect. How well you cope with this adversity will depend largely on your -adversity quotient,° and your need to develop coping skills. Joining a support group can be a very valuable source of emotional strength.

Not Doing Their Homework

The most important tool in your arsenal is information. Knowledge is power, and this is especially true for infertility treatment, which is potentially open-ended, expensive, and has an uncertain outcome. Donît minimize the problem or take an ostrich-in-the sand attitude and hope that it will go away. If you are well informed, you will be able to make your own decisions for yourself, to suit your own life plan and personality. There are no right answers in this field, only whats right for you. Trust your own heart.

Not Getting a Second Opinion

While itîs an excellent idea to trust your doctor, this should not be left to blind faith. Itîs always worthwhile to get a second opinion from an infertility specialist, to make sure you are on the right track. It's even better to get an opinion from a specialist who is not going to be treating you; this is much more likely to free of bias.

Losing Control

Patients who have unrealistic expectations from their treatment go through highs and lows that they find difficult to cope with. You need to have a plan of action, in which you hope for the best, but prepare for the worst. Donît think of any treatment on a single cycle basis. You have to learn (the hard way, unfortunately) to accept that nature is not very efficient at making babies!

Let's Try Something New This Time

Some patients want to try every new wrinkle every time they read a report in the newspaper. Remember that newspaper reports are deceptive and often give a one-sided view that emphasizes the successes. Itîs hard to trust media hype. Don't act as a guinea pig - let the technology mature. If itîs really good, it will be even better in another two years. Many fads come and go, and not all of them are truly helpful for patients (though they often help some doctors rake in quick bucks because its the latest thing to be doing!).

Repeating the Same Treatment Again and Again

As a rule of thumb, if a treatment has not worked in four cycles, you have reached the point of diminishing returns, and the treatment is not likely to be right for you. Itîs possible the next stage of treatment may be more expensive, but just because the right treatment is expensive is no reason to do the wrong treatment just because it is cheap!

Do these mistakes sound familiar? Have you made any of them? Donît kick yourself - put it down to a learning experience (you are now wiser!) and move on. Everyone is allowed to make one mistake once - just don't repeat it twice!

-Of all sad words of tongue or pen, the saddest are these: ÎIt might have been!î° While the final outcome of treatment is always unpredictable, you should have peace of mind that you did your best. Take the path of least regret.

Dr Aniruddha Malpani, MD
Malpani Infertility Clinic
Jamuna Sagar, SBS Road, Colaba
Bombay 400 005. India