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I recently saw an infertile patient who had over 3
thick files bulging with medical tests and reports. They must have
visited over 10 infertility specialists who had done every possible test
under the world to try to find out what their problem was. She had been
tested for antisperm antibodies, NK cells , hostile cervical mucus,
tuberculosis, chlamydia, sperm DNA fragmentation… you name it, and she
had had the test done. Each doctor had repeated test after test, but
each result was normal. They were at their wit’s end. “Why can’t I get
pregnant , doctor , if everything is normal ?” was her plaintive cry.
I was amazed at how little she had learnt after
visiting so many doctors. Instead of learning from her experience, she
was still asking the wrong question ! She expected me to order some more
tests, or use some newer machine to probe her insides and pinpoint the
elusive problem.
I had to remind her that the quality of the answer
we get depends upon the quality of the question we ask. No one cares
about problems – people only care about solutions. Rather than keep on
asking “What’s the problem ? Why aren’t I getting pregnant ?”, she
should instead be asking , “What can I do in order to get pregnant ?”
Ask a better question , and you get a better answer
! This was a totally new perspective for her, and I had to walk her
through this viewpoint. As I explained to her, it hardly mattered what
the reason for her infertility was – the only thing which mattered was
how we could fix the problem.
Everyone knows: GIGO – garbage in, garbage out. If
you keep on asking “What’s the problem ?” you will end up wasting a lot
of time, money and energy in trying to identify it. Unfortunately, many
of these diagnostic labels are inaccurate, unreliable or even completely
wrong. For example, a few years ago, many patients were diagnosed as
having an “inadequate luteal phase” – and even treated for this problem
! We now realize, with hindsight, that there is no such condition, and
we did a major disservice to our patients by coining this term and
making such a (mis)diagnosis.
It breaks my heart when I see how much time and
money infertile patients have wasted in pursuing a diagnosis. Is it the
endo , doc ? Could I be having antisperm antibodies ? These are all the
wrong questions , but we see this all the time.
Thus, after a failed IVF cycle , the first question
patients ask is - Why didn’t I get pregnant ? ( Interestingly, patients
who get pregnant after IVF never ask – Why did I get pregnant ? The
fact is that we cannot answer either of these questions – and often it’s
just a matter of chance ! )
The right question patients should be asking after a
failed IVF cycle is - What do I do next ? Often, the best option is to
repeat the IVF cycle. It’s a lot like buying a lottery ticket - there’s
no compulsion to do so , but if you don’t buy, you don’t win ! And the
oftener you buy, the better your chances of winning !
This is why, for most infertile patients, it’s
better to look forwards rather than to look backwards. The best question
is - What’s the next step ? It’s a good idea to make a list of all
possible treatment options – ranging from: stopping treatment and
remaining child-free; adopting; repeating the IVF cycle; doing the IVF
cycle at a new clinic; or using third party reproduction. You can then
eliminate the options which you are not willing to consider, so that you
are then left with the alternatives you are willing to explore. You then
need to focus on each of these, till you find the one which is best for
you.
Often, if you use this approach, you may find that
the absence of alternatives makes decision making easy , and you can
plan your next step and navigate your path through the infertility maze
with much greater ease !
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