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We do have a large number of older patients coming in for treatment. Most have poor ovarian reserves and high FSH levels and they want us to do IVF for them, using their own eggs. The first thing I tell them is that they have to be realistic and understand that the chances of them getting pregnant using their own eggs are dismal. In many instances, we end up cancelling the cycle due to this factor. At times, these patients don’t grow any eggs at all, despite the fact that we have superovulated them pretty aggressively.
The naysayers may wonder whether it’s really worthwhile doing this for them at all and whether it’s nothing but a futile exercise. They say it just gives the women false hopes and that it isn’t fair that the women have to be pumped with large amounts of hormones. The arguments these people put forth are endless really and they feel that it’s best that these women cut their losses at the right time and move on with their lives.
A matter of personal choice
All these questions are extremely difficult to answer as they are largely personal decisions that the patient herself has to make- the doctor doesn’t have the right to make this decision for his patients and the concept of right and wrong is more of a perspective rather than anything else.
Many patients want to have the peace of mind that they did their best and that they left no stone unturned in trying to have the baby they so wanted. I feel that the patient has to be given enough credit of being smart enough to make a decision that is right for her. The important thing is that the doctor has to be honest and upfront with them and ensure that the patient has realistic expectations of the treatment.
Refusing them even after they have made a well-informed and concerted choice would mean that the doctor takes away all their hope, which borders on cruelty. Given this situation, I do not think it is unethical for a doctor to refuse treatment to a patient whose chances of IVF success are very poor. Good doctors are ones that are considerate and those who value their patient’s decisions, rather than just refusing them flatly, because the chances of success aren’t very good.
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