IVF : The dark side of infertility treatment - View of Malpani IVF Clinic, India

There is no doubt that IVF technology represents one of modern medicine's success stories. Using IVF , we can help couples who could never have a baby with any other technique to start their own family.

However there is a dark side to IVF as well. All the media hype about IVF has created a lot of pressure on infertile couples. Most family members and friends naively think that IVF represents a sure shot success method, and cannot understand why infertile couples balk at going through IVF treatment. Moreover, since the media only highlights the success stories, patients themselves often have unrealistic expectations from IVF treatment. Unscrupulous clinics which quote highly exaggerated and misleading pregnancy rates simply add to the confusion.

Media coverage about infertility has also given birth to a new medical condition I call "pre-infertility". Preinfertile couples are usually young couples with no medical problems, who start to panic because they hear their biological clocks ticking. Even though they have no medical problems, and would have conceived in their own bedroom if they had given themselves enough time, they often rush headlong into seeking medical assistance . Unfortunately, many doctors are more than happy to provide this even though it is not needed, because such patients boost the clinic's success rates and give the doctor an undeserved reputation of being a good fertility specialist !

Because the treatment is so expensive, many doctors feel IVF is a lucrative business proposition, as a result of which many IVF clinics start simply to make money. They then pressurise infertile couples ( who could get pregnant with simpler treatment options) to go in for IVF, leading to unnecessary overtreatment. Since these are often young couples with minimal medical problems, their pregnancy rates with IVF are high, thus boosting the clinic's success rate, and their reputation as well.

What happens in many IVF clinics is also very distressing. It pains me when I see patients who have been through many IVF treatment IVF cycles, but know pathetically little about their treatment details, because the clinic never provided them with this information.

Unethical doctors have also further ruined the image of IVF clinics. In order to boost their success rates, doctors have " donated " eggs and embryos from one patient to another - often without obtaining consent from either. The scandal at the clinic headed by Dr Ricardo Asch in California, USA made headline news, but one can only guess how many more similar instances occur which never see the light of day.

Embroidering pregnancy rates is an art some ART clinics are very good at. I know of some doctors who deliberately give their patients repeated HCG injections after embryo transfer, ( Inj Profassi, or Inj Pregnyl) and then measure the blood level of beta HCG a few days later to prove to the patient that she conceived ! Since the beta HCG level is positive, the patient naively believes she did get pregnant (when it become negative, the doctor explains that she miscarried) , little realizing that the positive test result was just a result of the HCG hormone administered to her in the injection !( If the doctor gave her husband the same injection, he would have a positive pregnancy test too ! ) Such a cruel trick not only gives the patient false hope which is dashed to pieces, it also hooks her to the clinic for life, since she "nearly" got pregnant in her previous cycle.

While such gross malpractise is thankfully rare, other subtle deficiencies are much commoner. Some clinics, for example, do not offer embryo freezing services, claiming falsely that pregnancy rates with frozen embryos are poor. They then use the surplus embryos they create during IVF either for research ( for example, to create embryonic stem cell lines), or for donation to other infertile couples, rather than storing them for the couple.

Even "internationally reputed" clinics resort to some underhand practices - and perhaps this is even more dangerous, because few patients dare to question them , given their reputation. Thus, some push unproven treatments such as immunotherapy for recurrent pregnancy losses, offering their patients false hope after making them spend lots of money. Since these treatments are still controversial and unproven, it would only be fair to offer them as part of a controlled clinical trial, at no charge to patients. However, these patients are often so desperate, that they are happy to grasp at straws - especially when these are cloaked in the garb of scientific gobbledygook.

Since knowledge is power, the best way of protecting yourself is by becoming well-informed, so you can critically assess the "facts" for yourself. Books are excellent starting points in your quest for information, and you can start by reading our book, How to Have a Baby, which is available free online !

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

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