Every patient who starts an IVF cycle does do with the hope that it will be their first and last cycle. IVF represents their last hope ; and they understand that this is the one technology, which maximizes their chances of getting pregnant - it is often the court of last resort, on which they bet all their dreams ( and often their last rupee) . However, not only is IVF expensive, it also causes a lot of emotional distress, which is why everyone wants their IVF cycle to be successful .

This is a perfectly rational and reasonable hope, but this sometimes sets up unrealistic expectations, which can cause a lot of grief, not just for the patient, but for the doctor as well. If patients have unrealistic expectations, and the cycle fails, they are often not able to deal with this failure if they have not been adequately counseled which is why they will often vent their anger on their doctor. Many patients who fail IVF will blame the doctor and end up believing that the doctor was incompetent; or did not do a good job .

Part of the problem is that doctors also contribute to patient's unrealistic expectations . Every doctor wants to treat every patient who comes to them, because doing IVF can be financially remunerative. This means that instead of setting realistic expectations and educating patients as to what the chances of success actually are, a lot of IVF doctors end up overpromising the moon to their patients before the cycle starts . At the time of the consultation, the doctor is extremely optimistic and positive ! " No problem - we are the best and I am sure we will be able to give you a baby !" When the cycle fails, the same doctor does not want to deal with an upset, angry and unhappy patient, and will often make himself inaccessible and refuse to see the patient . The patient feels abandoned ; which just makes the patient even angrier. He feels he was cheated and that the doctor is a crook. This feeling is often reinforced when the patient asks another IVF doctor for a second opinion. The new doctor, armed with hindsight, will point out a lot of holes and deficiencies in the treatment protocol followed by the first doctor - after all, he does have to prove to the patient that he is a better doctor !

It's very easy for doctors to talk sweetly and promise a baby at the start of the cycle ; but the hallmark of a good doctor is that he will take the time and trouble to explain to patients what their chances of success actually are. I tell all my patients that while I'm very optimistic, it's important for them to prepare for failure, so that they can take this in their stride, in case their IVF cycle fails (which a lot of cycles end up doing).

It's quite easy to convince patients to do an IVF cycle ; and a lot of clinics will use dodgy ploys to do so. For example, they will quote success figures which are not their personal figures, but the best possible figures, as published by the best IVF clinics in the world ! In reality, most IVF clinics will not be able to achieve these figures, and the best ones seem to be outliers for completely unexplained reasons. However, every clinic uses these figures as their own figures ; and this causes patients to get misled .

It's not easy to tell patients that the IVF cycle may fail, and doctors are reluctant do this, because they are scared that if they tell patients the truth upfront, the patient may get worried and may not come for an IVF cycle to them. What makes this even worse is that because some doctors provide false figures, other doctors, in order to compete with them, start inflating their own figures, as a result of which the entire exercise seems to become a compilation of the doctor's fantasies. It's remarkably easy for doctors to manipulate infertile patients, because they are so emotionally vulnerable.

It is important for patients to do their due diligence ; have realistic expectations ; and understand that while an IVF cycle may work, it also may not ; and that often the IVF journey does involve multiple attempts . If they are prepared for this, it's much easier for them to deal with the ups and downs of the IVF journey.

Unhappy patients make for unhappy doctors; and unhappiness is a result of mismatch between expectations and reality . If patients have unrealistic expectations of IVF success - and especially if doctors contribute to these - this will just end up in disaster for both patient and doctor if the IVF cycle fails !

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

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