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While it is true that IVF maximizes a patient’s
chance of conceiving quickly, the sad fact is that IVF has become very
complex today. Normally, as a technology matures, it usually becomes
simpler and easier to implement, but this has not been true with IVF,
especially the way it is done in most IVF clinics in the USA today.
IVF in most clinics is very regimented and protocol
driven. IVF treatment is usually supervised by nurses who often apply
cookbook protocols mindlessly to all their patients. This means that
they are not able to adapt the protocols to an individual patient’s
needs, so that while the “average” patient does reasonably well in most
clinics, “difficult” patients fare poorly.
Since there is so little involvement of the doctor
in the IVF cycle, IVF clinics have devised a complex series of steps
which all IVF patients need to go through, to ensure that the nurses do
not “miss “ anything out. The doctor then simply needs to check that
these steps have been performed by the nurses , so that no one is really
applying their mind to each individual patient’s response.
Typically, an IVF cycle involves:
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A long list of tests prior to starting an IVF
cycle. Most of these tests are of no use whatsoever, because they do
not affect the treatment or its outcome. However, they all need to
be performed mindlessly, because “that’s the way we do things here”
! No one has ever bothered to evaluate whether these tests are
useful or cost effective, so they continue to be done “routinely”
for all patients. To add insult to injury, most clinics will not
accept results from non-US labs or clinics, so patients are forced
to repeat all their tests again – a sad drain of resources and
energy.
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Most clinics follow a long protocol for
superovulation. Often patients are pre-treated with a month of birth
control pills; and then downregulated with lupron which starts from
the month prior to the actual IVF cycle. This often means that a
typical IVF cycle takes over 6-8 weeks to complete !
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During the IVF cycle, patients are subjected to
daily blood tests. While most IVF doctors will privately agree that
most of these tests are just a waste of time, it’s become a
“ritual” to do them on a daily basis – and no one is willing to
question this holy cow. While ordering these tests on a selective
basis can be useful in some patients, there really is no
justification to use patients as a pin-cushion and to do them daily.
This often means that each IVF cycle usually ends up
taking 2 months, and often drains a patient emotionally ( and
financially). It’s bad enough being infertile, but going through IVF in
most clinics just adds to the stress. However, keeping the treatment
complex helps doctors in the US to justify the abnormally high fees they
charge – over four times as much as comparable clinics in India !
There is a major need to simplify IVF, to make it
more patient friendly. Fortunately, some clinics in Europe have kept an
open mind, and have pioneered this approach, with excellent pregnancy
rates.
This is the simplified protocol we have used
successfully for over 12 years
1. The only tests we need prior to IVF are tests to
check the quality of the eggs , sperm and uterus. This means we need
only the following:
a. semen analysis
b. blood tests for FSH,LH,PRL and TSH
c. vaginal ultrasound scan to confirm the uterus is normal
2. We use the short protocol for downregulation,
which means all IVF treatment starts from Day 1 of the cycle
3. We monitor egg maturation with the help of
vaginal ultrasound scans. Since we do it ourselves, it’s easy to
correlate scan results with the treatment given, and to modify the
treatment accordingly. We do not do any blood tests during the IVF
cycle.
4. We provide luteal phase support with progesterone
suppositories. We do not give the painful injections of progesterone
after transfer, because there are much less effective than vaginal
progesterone.
This means our IVF treatment protocol is easy,
simple, less stressful, with a high pregnancy rate, and is much more
patient-friendly and more repeatable .
However, it does needs a full-time dedicated IVF
doctor who does nothing else. This is the reason it’s not popular in the
USA, where doctors are too busy doing other things; or share duties on a
rota system, which means that a patient very rarely sees the same doctor
a second time.
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