Root cause analysis for IVF failure


We treat lots of engineers and computer programmers who are infertile , and when their IVF cycle fails, they ask us, "Can we please do a root cause analysis to find out why the cycle failed?"

After all, they are engineers and think logically and analytically. They want definitive answers , and are upset when we can't provide these. Root cause analysis works extremely well when you're dealing with inanimate objects, but unfortunately, what applies to machines cannot be extrapolated to human beings.

This doesn't mean that doctors are illogical or lazy - it just means that our technology has limitations, and we can't always answer a patient's questions because there are too many complex variables and moving parts in an IVF cycle.

When we explain this to patients , they're not very happy , because they expect their doctor is an expert who will be able to provide answers. The reality is medical science has constraints, and we can't track the fate of an embryo after we transfer it into the uterus.

This is why it's hard to pinpoint what the causative factor for an individual patient's IVF failure are . Biological variables changes all the time, because this is a complex adaptive system, and providing simplistic answers just to pacify the patient does not help anyone.

There's no point in doing unnecessary tests and unnecessary treatments simply in order to pander to a patient's query. It's much better to be upfront and honest with the patient and say, " Sorry, there are some questions we can't answer yet. However, just because we can't identify the exact problem is not a cause for worry. We are very good at finding solutions bypassing problems , even if we don't know what they are precisely". This can be very reassuring for patients - after all, an IVF clinic is not a research enterprise - our goal is to give our patients a baby, and this is something we are very good at !

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Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.