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Should doctors offer IVF treatment for patients where if it's likely to futile ? Who is to decide ?

I recently saw a patient who wanted me to do IVF for her. She had an extremely high FSH level of over 40 mIU/ml which clearly meant that she had ovarian failure. The chances of her being able to produce viable eggs which we would be able to use for IVF were extremely low.

She was a thoughtful intelligent patient who had a clear understanding of her medical problem and also understood that her treatment options were extremely limited. She was very sure that she did not want to use donor eggs and was wondering if I would be willing to do an IVF cycle for her. She was quite hesitant about making this request because she had been refused by many IVF specialists in the past. She felt that I would also refuse her request, which is why she made this very tentatively.

Maintaining realistic expectations 

I sat down and explained to her that as long she had realistic expectations from me and the treatment I could offer her , I would be happy to take her on as the patient. I did not want to give her any false hope or tell her that her chances were good.

However she explained to me that she clearly understood that her prognosis was extremely poor but she still wanted to go ahead with treatment and since she could not do it herself, she requested me for my help.

Expensive treatment 

I had to think long and hard as to whether I was right in saying yes to her or not. Putting her through an IVF cycle would involve giving her a course of injections to help her to try to produce eggs. These injections were expensive and were very unlikely to work in her case. However, she understood this and was quite willing to spend the money.

The ethical route 

So was it right on my part to refuse to prescribe these injections for her , even though I knew that the chances of them working would be extremely poor? Was it ethical for me to offer her treatment even when I knew that the chances of succeeding were very poor?

Wasn't I really just creating false hope and making her go through an additional 10 days of an emotional roller coaster ride with very poor chances of success at the end of it all? Wouldn't it just be much easier and kind of for me to just say no, just like her other IVF doctors had done?
I struggled with these questions and then finally decided that it would actually be unethical on my part to refuse to treat her , as long as I was crystal clear that she understood exactly what she was choosing to put herself through, and understood what I could do for her and equally what I could not.

The only risk 

She was already very upset that she had not done the IVF treatment 5 years ago when she was a lot younger, and she did not want this last chance to slip out of her fingers. Since these injections were natural hormones and did not carry any medical risk, I was clear that I would not be jeopardizing her health in any way.

The only risk really would be a financial risk because these were expensive injections , but this was something she clearly understood and was willing to take on. There was of course the additional emotional risk that she would be unhappy if her eggs did not grow.

However, this was something she clearly understood and was still very keen to continue with the treatment. I did my best to discourage her and explained to her that we did have other alternative options such as adopting or using donor eggs , but she was very adamant that she did not want to discuss these at the present moment. I finally came to the conclusion that it would be in her best interests to go ahead with treatment , even if the chances of it succeeding were very poor.

She would be no worse off than what she already was, would she? She did not have a baby and even at the end of the treatment if she didn't grow any eggs, she would still not have a baby. However, one advantage of going through the treatment cycle would be that it would give her peace of mind that she had tried her best , so she would never have any regrets later on that she'd left any stone unturned.

Respecting patients decisions 

I finally decided that it was only fair that I agree to her request because it was a reasonable request being made by a well-informed patient. I believe in respecting patient autonomy and allowing patients to make their decisions for themselves, even though I might not agree that these were medically sound decisions, as long as the decision would not impact her physical health.

I decided it would be fair on my part to help her to come to terms with reality, so that she could achieve emotional closure and then continue to move on with her life, no matter what the outcome of the actual IVF treatment cycle is.

Do you agree with me?

Read moreCost of IVF


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

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