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I just saw a 38 year old patient who had a low AMH level. She had been advised IVF, and wanted a second opinion as to whether this was a good option for her. Given her advanced age and her low AMH level, I told her that she had reached the oopause. I agreed that she needed IVF, because time was at a premium for her.
When I said this, she because very agitated. I did my best to try to calm her down, but she seemed to get even more anxious. " What are you worried about ? Pain ? side effects ? the expense ? "
" No, doctor, I am worried that I am now too old. I know that my low AMH level means my eggs are poor quality, and that there is a high chance that the IVF cycle may fail and I may never have a baby !"
- The fear of failure is the biggest concern for most patients who are considering doing IVF. However, many manage this anxiety very poorly
- For one, they do not articulate it well, so that it then becomes a diffuse general free-flowing anxiety which starts disrupting their life
- Some prefer remaining in a state of denial, because they just cannot screw up their courage to face up to the ugly truth that not all IVF cycles result in a baby
- Others prefer keeping a "positive attitude" because they naively believe that if they are optimistic, "all will be well" - and that unnecessarily stressing about the outcome can reduce their chances of success
Expressing is important
It's far better to allow the patient to ventilate and express her fears, so these can be managed properly. Unexpressed anxieties are likely to fester and cause emotional scarring later on.
Is there any quick fix ? Unfortunately, no. Most patients are intelligent enough to know that it's not sensible to worry about something which you cannot do anything about - but while the mind understands this, it's hard to get the heart to agree !
I tell patients that you are paying me , so please let me do the worrying for you! My worries are about medical concerns , which are likely to lead to constructive solutions ( how can I tweak the superovulation to maximise chances of success) - so you can focus on growing lots of eggs !
Please remember the Serenity Prayer
God grant me the serenity to accept the things I cannot change;
the courage to change the things I can;
and the wisdom to know the difference.
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