Every woman steps into the world of IVF with the hope that IVF will give
her a deeply desired baby. Unfortunately
not everyone who undergoes IVF ends up with a baby to take home . Every IVF cycle provides you with a 40-50 %
chance of getting pregnant (this success rate is for young women with good
ovarian reserve provided they are with a good IVF clinic, their uterus does not
have any obvious defect and their partner is fertile) and the chance of take
home baby (live birth rate) is lesser ! Women
who are of advanced maternal age (greater than 35 year old) and women who
produce only a few eggs due to poor ovarian reserve have a lower chance of
success. This is the bitter truth.
We all need hope to stay motivated. The motivation to fight the unknown
and the inspiration and energy to deal with uncertainty definitely comes from
hope. No one will step into IVF treatment without hope and motivation. But when hope turns into false hope and
delusion, patients are headed towards heartbreak and pain. I even find searches like this leading to my
blog – ‘my IVF cycle failed, I want to suicide’. If a failed IVF cycle triggers the desire to
end one’s life then readers must understand how huge the emotional turmoil the
patient might be undergoing! Another search word I frequently see is – how to
cope with a failed IVF cycle. What makes
coping with a failed IVF cycle so difficult? What is the difference between
hope and false hope in the context of IVF? Does the same hope which provides
the motivation to fight steal the courage to face the failure?
The field of IVF is highly commercialized. Many IVF specialists sell
false hopes in order to lure patients to their clinic. Also, because of their
extreme desire for a baby , many IVF patients become delusional and live with false hope.
They look at IVF with rosy lenses because it’s their last chance and
desperation makes it difficult to think clearly. They over-estimate their
chance of success - and back up such false hopes with unrealistic facts and
expectations.
There are many ploys they use to justify this false hope.
-
That celebrity
had her first baby at 45 with IVF , which means I can have one too
-
I read in
an online infertility community about a woman who got pregnant after
acupuncture at the age of 43, which means there’s hope for me too, no matter
what everyone else says
-
Statistics are fine, but they don’t apply to
individuals, and because I am healthy and fit and god-fearing, God will
definitely give me a baby.
-
The author
of Inconceivable conceived a healthy baby with such a high FSH after making
life style changes, so if she could conceive, I can too.
Are these women just fooling themselves ?
When undergoing IVF, hope must be
based on reality and facts. You must cultivate hope based on sound scientific
evidence. False hope can be cruel , because your heart breaks when you are
forced to encounter harsh reality.
She produced only 1 or 2 eggs in her IVF attempts and her embryos arrested
after day 2. She has a very high FSH and
low AMH. It clearly shows that her ovarian reserve is nearly depleted and the genetic
competence of her embryos is poor. But she insists that she doesn’t want to use
donor eggs and will try acupuncture to improve her egg quality so that she can
get pregnant. Now until she produces
eggs which could be fertilized and give rise to a healthy embryo, there is no chance
for a pregnancy. Now the question is - how high are her chances? If we look at
the figures from IVF clinics all over the world, her chance of success using
her own eggs will be less than 3 %. That
is, if 100 women of her age and diagnosis undergo IVF, three might
get pregnant and the chance of a healthy offspring is much lesser, because the
miscarriage rate is very high in these women ! IVF is costly; and the emotional
and physical strain it can put on someone is high as well . In such a situation
how many times she will be able to play the IVF roulette without becoming an
emotional wreck, especially, when there is only a miniscule possibility for a
favorable outcome?
Her false hope stems from two aspects: her desperation to have her own
baby and her willful ignorance. While denial can be a useful protective
mechanism, it can cause a lot of harm. She fails to understand the reality of scientific data, and is living in a fantasy
land (because of her dreams of having her own genetic baby , and also by
reading many anecdotal success stories) . She is hopeful that if she tries
acupuncture ( or any other therapy ), a miracle will happen. This is also the
case with many young women who have very poor ovarian reserve. One must
understand that miracles do happen but very, very rarely – and this is why they
are called miracles ! Exceptional stories like that of the author of
Inconceivable do happen , but it cannot become the norm! Not every woman who
has a high FSH level conceives after making ‘adequate’ life style changes. Sadly, we never get to read their “ IVF
failure stories “ !
Relying on such anecdotal stories and ignoring sound scientific data is
like buying a lottery ticket and waiting to become a millionaire , just because
someone else you know has won a huge jackpot. Any rational human will agree that
it is utter foolishness to do so. In short, because of your desperation, you
are allowing someone else to laugh all the way to the bank - and even worse , you
are doing so by emptying all your hard earned money! This kind of over-optimism
will not only harm your bank balance , but also your emotional well-being.
A good IVF doctor will clearly explain to you your low chance of success
and will advise you to consider alternative, such as using donor eggs. He will
not lure you into trying unproven expensive therapies , such as immunotherapy .
In fact , some genetic tests like Preimplantation Genetic Screening (PGS) have
been shown to decrease the chance of success in older women undergoing IVF,
even though the IVF clinics which offer them promise the moon! In short, a good
physician will not sell you false hopes by overstating your chance of success. Please
be happy when you meet a doctor who is honest with you because he is the one
who genuinely cares for you. Do not get taken in by sugar-coated words by
doctors who are trying to sell you their expensive services.
Remember, a cruel truth is always better than false hope. You must let go of false hope and fill
yourself with acceptance of your real situation. This will be the best step
forward to bring peace and happiness , and it will also help you decide wisely
about your next steps.
There are also young women with good ovarian reserve who have highly unrealistic
expectations about IVF. They believe they will definitely succeed in their
first IVF cycle. They think only of a successful outcome and shun all thoughts
about a negative outcome. Many believe that even thinking about a negative
outcome will jinx their chance of success. Some put all their faith in God and
obsessively pray 24/7 for their IVF cycle to succeed. When such women face
failure , they find it very hard to cope. Facing success doesn’t need any prior
preparation but for facing failure you have to prepare your heart and mind
beforehand. You have to develop effective coping strategies to face IVF failure,
just in case your cycle does fail. Seeking strategies to cope after a failure will
not work effectively.
Even if you are young and have
good ovarian reserve, your chance of success with a good IVF clinic is just
40-50%. This means your chances of failure are as good as your chances of
success. Statistics show that 60-70% of women succeed within 3 IVF attempts ,
while others will not conceive at all!
You will understand the need to have a plan B if plan A doesn’t work.
Blind hope will only lead to depression and enormous emotional pain. If you
don’t learn to deal with the possibility of failure by designing proper coping
strategies, the fear of failure itself can stop you from pursuing your dream.
It appears as if false hope is what gives you the strength to fight, but
what it actually ends up doing is leaving you emotionally drained after the IVF
roller coaster ride. A balanced sense of hope is extremely important , so you
don’t drive yourself insane. Realistic expectations come only when you educate
yourself thoroughly. A realistic hope is
flexible as a negative result does not break you , but helps you to cope better
, so you can make optimal use of all the options that are available to you in
the field of IVF. A realistic hope admits uncertainty. When false hopes come crashing down, you are
likely to be resentful and angry – and you will often need to vent this on the
IVF doctor who helped to create some of the high expectations.
A realistic expectation of IVF is not always a baby , but receiving good
medical treatment , and making use of all the scientifically sound options that
are available to help you to reach your dream.
IVF doctors have an important role to play. They must realize that it is
extremely cruel to sell false hope to their patients who are fighting to have a
baby. IVF is usually a happy specialty
because we help to create life. However, we do sometimes have to give bad news
to patients, and this can be hard to do. For example, what do you tell a 45
year old woman who has failed 3 IV cycles and has a high FSH level and wants to
do one more IVF cycle with her own eggs. By telling her chances are slim, are you being
unfair and unkind by depriving her of hope ? By saying No, you are passing a death sentence
in one sense – the death of her dream of having a baby with her own eggs.
Is it better to be frank and forthright ? It’s no fun having to counsel
patients who are not willing to listen to the truth . It’s much easier for IVF
doctors ( and more profitable too !) to go along with their patient’s wishes,
even when the chances of success are zero. A lot depends upon the maturity of
the doctor – and the patient as well ! Is the patient willing to absorb the
truth ? Does she understand that only an upright medical professional will tell
her what’s in her best interests, rather than try to sugarcoat the truth ? Does
she trust her doctor ? Has she done her homework ?
Remember that a failed IVF cycle does not mean you are a failure. When
one door closes, another window opens up. IVF can teach you a lot of life
lessons, and while these are not easy to imbibe, rather than become bitter,
angry and unhappy, you can end up becoming more mature and empathetic , if you can
weather this storm in your life.
This article is the brain child of Dr. Malpani and me. Thank you so much Dr !
