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There is a wide variety of infertility treatments, but none of them provide a  guarantee of successful conception. The key is to make decisions that maximize your benefits and minimise your risks.

In the Right Direction 

A good infertlity expert will guide and support you to take responsibility, and make your own decisions. This participative and empowered approach goes a long way in enhancing your peace of mind. Infertility treatment is full of potholes, roadblocks, diversions and traffic-jams. You need to learn to navigate your way through this inhospitable route.

One of the most difficult tasks you will need to master is how to make decisions. Many patients want to use their doctor as a navigator , so that the commonest question is - Doctor, what should I do next ? Being infertile can be stressful - and so can being an infertility specialist ! 

The Questions 

  • Why did the cycle fail ?
  • What do I do next ?
  • How many embryos should I transfer ?
  • Should I do another cycle or should I adopt ?

Unfortunately, we can only explain about one-third of things which happen ; one-third is educated guessing; and about one third we have no idea and can't explain why it happened. It's not much fun not having the answers, but this can be a humbling experience ! This is why I prefer treating well-informed patients, who have realistic expectations of what we can do - and what we can't !

Read more- The well-informed patient versus the well-informed doctor

Empowering Patients 

As a doctor, I am the "expert" , and it's very tempting to tell patients what to do - to provide all the answers. In fact, many patients expect this, and are quite upset when I refuse to tell them what to do next. I ask them to decide for themselves, since I believe in non-directive counseling

I feel I need to empower my patients , so they can make their own decisions for themselves ! I promise them I will never let them make a wrong decision, but when there are choices, they need to decide for themselves.

Making decisions is always difficult, because when you select one choice, you are rejecting another at the same time. And there is always this niggling doubt in the back of your mind - am I doing the right thing ? Is this my best option ?

 As Robert Frost put it so eloquently in his poem, The Road Not Taken. " I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I - I took the one less traveled by, And that has made all the difference."

Devise a Strategy 

You need to devise a strategy which maximizes your perceived benefits and minimises your risks. Because everyone has a different perception of what acceptable risks and benefits are, this is a very personal decision. For example, some patients would be delighted to have twins; while for others, this would be a disaster. The trick is to work backwards - list all your options, and then decide which ones are acceptable and which are not.

How Many Embryos Do I Transfer?

Let's look at the common dilemma of how to select the right number of embryos to transfer. I tell all my patients, if the technology was perfect, there would be no problem - we would transfer one embryo for everyone, and everyone would have one baby!

Unfortunately, because the technology is not perfect, we need to transfer more embryos in order to increase the odds of at least one implanting. But, as with everything else in life, there is a price you may for this - more is not always better. If we transfer more embryos, there is a greater risk of a multiple pregnancy, and the obstetric risks associated with this.

This means there are 3 possible outcomes - 1 good; and 2 bad. The good outcome is getting pregnant with one ( or two). There are two possible bad outcomes - not getting pregnant at all; or getting pregnant with a high order multiple. Now, you need to decide which of the two bad outcomes is "less bad", so you can make the decision which is correct for you.

Follow Your Heart 

For some patients, triplets would be a major disaster, and they refuse to consider the option of fetal reduction. For other, not getting pregnant would be the biggest catastrophe, and they would rather have "three in the hand, rather than nothing in the bush". This is a constant dilemma, and it never becomes easy to resolve it . The only guideline I can offer is - follow your heart, not just your head.

There are no "right " answers. If there were, then your doctor would make these decisions for you ! You need to choose whatever gives you peace of mind. It's best to take what I call the "path of least regret" . Remember that you rarely regret the things you did but you often regret the things that you did not do.

Read more- How many embryos should I transfer ?

Dont always look for rationale 

Often, not may feel that your decision is not "rational" . This is fine - just follow your gut feel and do what's right for you. If you are not happy, you can never keep anyone else happy. A good doctor will allow you to make your own decisions - even the "wrong" ones which he may not agree with.

You may find that your thinking is "crazy " or you may even suspect that you are going crazy yourself. This maybe because you were not even aware that your desire to have a baby could be so strong and overwhelming , and this can be scary, especially when you have always prided yourself on being cool , calm and collected.

Be kind to yourself ! You are not abnormal - it's the situation you are finding yourself in which is abnormal. Under these abnormal circumstances, behaving "abnormally" is actually normal. Remember that it's your life , and you need to be mature enough to accept the consequences of your decisions. This means that you cannot leave your head out of the decision making process.

Tough Decisions 

There are many real-world factors you will need to factor in, such as the expense of the treatment, and you will need to realistically assess your chances of success as well. Wishful thinking will not help, but making these touch decisions will actually help you become a better human being !

Remember that infertility treatment is not just about success or getting pregnant - it's a whole lot more. IVF should also help you achieve closure and resolution, no matter what the outcome of the treatment. It's equally important that it give you peace of mind that you tried your best , so that you can move on with your life.


There is a wide variety of potential infertility solutions, but there is no guarantee of successful conception. The key is to make decisions that maximizes your perceived benefits and minimises your risks. 

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

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