Mrs Radhika Desai was
my last appointment of the day, and she had a thick
medical file which described all the medical tests and
treatments she had been through. She had consulted doctors
in 3 continents, and was now seeking another medical
opinion for her problem of unexplained infertility.
She had had over 4 laparoscopies, performed by various
doctors in different parts of the world – and
had had been through 6 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 doctor’s 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 which 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 don’t get suboptimal
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 may be a fertility
problem.
Refusal to consider alternative treatment options. This
is a common mind block, especially amongst men. Many
of them believe that treatment is “unnatural”
or artificial, and they would rather have a baby who
was conceived in the bedroom. It’s 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 crisis you will encounter,
when you have to confront your biological frailty. More
over, it’s a problem which 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 to a large extent on your “adversity quotient”
– and you 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 armamentarium is information. Knowledge is power
- and this is especially true for infertility treatment
which is potentially open ended, expensive and has an
uncertain outcome. Don’t 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 decision for yourself, to suit
your own lifeplan and personality. There are no right
answers in this field – only what’s right
for you Trust your own heart.
Not getting a second opinion. While it’s an excellent
idea to trust your doctor, this should not be blind
faith. It’s 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 which
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. Don’t think of any treatment
on a single cycle basis – you have to learn 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 which
emphasises the successes – it’s hard to
trust media hype. Don’t act as a guinea pig –
let the technology mature. If it’s really good,
it will be even better in another 2 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 it’s 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 4 cycles,
you have reached the point of diminishing returns, and
the treatment is now likely to be right for you. It’s
possible that 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 one
of them? Don’t kick yourself – put it down
to a learning experience ( you are now wiser!) and move
on! Everyone is allowed to make one mistake once –
don’t repeat it twice!
“Of all sad words of tongue or pen, The saddest
are these: 'It might have been!'” 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
I first wrote this for the ezine published by Conceiving
Concepts. Check out their website at www.conceivingconcepts.com
if you'd like to subscribe to it - it's packed with
useful information!
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