While it is true that IVF maximizes a patient's chance of conceiving quickly, the sad fact is that IVF has become very complex today. Normally, as a technology matures, it usually becomes simpler and easier to implement, but this has not been true with IVF, especially the way it is done in most IVF clinics in the USA today.

IVF in most fertility clinics is very regimented and protocol driven. IVF treatment is usually supervised by nurses who often apply cookbook protocols mindlessly to all their patients. This means that they are not able to adapt the protocols to an individual patient's needs, so that while the "average" patient does reasonably well in most fertility clinics, "difficult" patients fare poorly.

Since there is so little involvement of the doctor in the IVF cycle, IVF clinics have devised a complex series of steps which all IVF patients need to go through, to ensure that the nurses do not "miss" anything out. The doctor then simply needs to check that these steps have been performed by the nurses , so that no one is really applying their mind to each individual patient's response.

Typically, an IVF cycle involves:

  1. A long list of tests prior to starting an IVF cycle. Most of these tests are of no use whatsoever, because they do not affect the treatment or its outcome. However, they all need to be performed mindlessly, because "that's the way we do things here" ! No one has ever bothered to evaluate whether these tests are useful or cost effective, so they continue to be done "routinely" for all patients. To add insult to injury, most fertility clinics will not accept results from non-US labs or clinics, so patients are forced to repeat all their tests again - a sad drain of resources and energy.
  2. Most fertility clinics follow a long protocol for superovulation. Often patients are pre-treated with a month of birth control pills; and then downregulated with lupron which starts from the month prior to the actual IVF cycle. This often means that a typical IVF cycle takes over 6-8 weeks to complete !
  3. During the IVF cycle, patients are subjected to daily blood tests. While most IVF doctors will privately agree that most of these tests are just a waste of time, it's become a "ritual" to do them on a daily basis - and no one is willing to question this holy cow. While ordering these tests on a selective basis can be useful in some patients, there really is no justification to use patients as a pin-cushion and to do them daily.

This often means that each IVF cycle usually ends up taking 2 months, and often drains a patient emotionally ( and financially). It's bad enough being infertile, but going through IVF in most fertility clinics just adds to the stress. However, keeping the treatment complex helps doctors in the US to justify the abnormally high fees they charge - over four times as much as comparable clinics in India !

There is a major need to simplify IVF, to make it more patient friendly. Fortunately, some clinics in Europe have kept an open mind, and have pioneered this approach, with excellent pregnancy rates.

This is the simplified protocol we have used successfully for over 12 years

  1. The only tests we need prior to IVF are tests to check the quality of the eggs , sperm and uterus. This means we need only the following:
    1. semen analysis
    2. blood tests for FSH,LH,PRL and TSH
    3. vaginal ultrasoundscan to confirm the uterus is normal
  2. We use the short protocol for downregulation, which means all IVF treatment starts from Day 1 of the cycle
  3. We monitor egg maturation with the help of vaginal ultrasound scans. Since we do it ourselves, it's easy to correlate scan results with the treatment given, and to modify the treatment accordingly. We do not do any blood tests during the IVF cycle.
  4. We provide luteal phase support with progesterone suppositories. We do not give the painful injections of progesterone after transfer, because there are much less effective than vaginal progesterone

This means our IVF treatment protocol is easy, simple, less stressful, with a high pregnancy rate, and is much more patient-friendly and more repeatable .

However, it does needs a full-time dedicated IVF doctor who does nothing else. This is the reason it's not popular in the USA, where doctors are too busy doing other things; or share duties on a rota system, which means that a patient very rarely sees the same doctor a second time.

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

Open Video