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Failing an IVF cycle can be heartbreaking, and it can be difficult for the doctor to advise the patient what to do next. This is true when the cycle has gone very well; and even when it hasn't .
Let's take the example of a patient with a poor ovarian response. You know that her best medical treatment option would be to use donor eggs, but the patient is adamant , and has decided she doesn't want to use donor eggs under any circumstances. You believe that repeating the IVF cycle with her own eggs would be an exercise in futility, and you're very reluctant to make her waste her money, but she's not willing to agree with your opinion.
What do you do next ?
You can't force your decision down a patient's throat, because IVF treatment is elective, and patient preference is extremely important.
When we reach this impasse, there are three things we recommend our patients do, so they can move on with their life, and don't get paralysed into inactivity.
We suggest that they meet a counselor - a psychologist or a reproductive health specialist - someone who can help them look into their own heart, so they can make a decision which they can live with.
If they are religious, we suggest that they seek guidance from their spiritual leader. This can be helpful because he can help you put the problem in the right perspective. A failed IVF cycle is not the end of your world, and while a failure causes grief, there is a lot which you can do to help you bounce back. A spiritual perspective will help you regain your resilience.
Finally, we suggest that they get a second opinion from another IVF clinic. This is helpful , because if two different doctors tell them the same thing, then it's easier for patients to accept the medical advice they are hearing, even if they find it unpalatable. Even if the truth is bitter, you need to accept it. On the other hand , if the other doctor has a better alternative, I'm very happy for the patient to consider this option, because I have nothing more to offer her in any case.
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