The most important question patients need to ask themselves before starting an IVF cycle is - What will I do if my IVF cycle fails ?

After explaining to a patient what is involved in an IVF cycle, the last question I ask them is - What is Plan B ? Many don't understand the question - and some of them actually get upset when I ask this. However, as I explain to patients , it's important that they don't put all their eggs in one basket (pardon the pun ). They need to have realistic expectations of the technology , so that in case it doesn't work, they don't go to pieces and know exactly what to do next.

A common problem with IVF patients is that they approach their IVF treatment on an ad hoc basis. Everyone starts an IVF cycle with the personal belief and private hope that this will be their first and last IVF cycle . If every patient didn't think so, most of them would never start the cycle in the first place.

However, this is an unrealistic expectation , and while it's great to hope for the best , patients need to prepare for the worst, which is why they need to know what they are going to do in case the cycle doesn't work. If they don't make these preparations , the IVF treatment often becomes like an emotional roller coaster ride which becomes very hard to cope with.

Many patients are just not prepared for the possibility of the cycle failing . They’ve been brainwashed into being positive, and will go to pieces if the cycle fails . Not only do they blame themselves ( I must not have been positive enough !) , they get so paralyzed and emotionally distraught that they just cannot think about starting again . Not being prepared for failure ends up causing them a lot more grief and harm.

Many patients don't like this question because they feel that I am being excessively negative and pessimistic - or even worse, that I'm not very sure of my own technical skills , which is why am talking to them about failure. However, I am extremely competent and provide high quality medical care. Even though I am an optimist , I think the best time to prepare for Plan B is when you don't need it !

Not having a Plan B is the worst possible plan to have , because then you're allowing chance to make your decisions for you ! Trying to think straight when the cycle has failed is practically impossible , so that you often end up making decisions which you regret later on.

The easiest thing to do is to make a list of all your options , and then work your way step-by-step through these . It’s a good idea to explore your options in parallel rather than sequentially , because this ends up saving you a lot of time grief and energy. Thus, for example if you want to consider adoption, I advise patients to at least visit an adoption agency - and perhaps even register your name . If the IVF cycle works , you can always take your name off the adoption waiting list – no one will force a baby down your throat if you change your mind. ( In fact, they may be happy that the waiting list has become shorter because you have taken your name off it). The second most important thing to remember is that you should keep an open mind – don’t prematurely say no to any option, no matter how unpalatable it may appear at present . If you are aware of the fact that you have multiple options available , you will realize that you are in control of your life , and this will make going through the treatment a lot easier for you.

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

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