GIGO AND INFERTILITY
The ability to ask the right questions about infertility
will ensure you save valuable time and effort.
I just saw an infertile patient who had more than 3 thick
files , bulging with numerous medical tests and reports. They had sought advice
from over 10 infertility specialists, who had recommended every possible
medical test under the sun possible to figure out what their problem was. They
had tested her for antisperm antibodies, NK cells, hostile cervical mucus,
tuberculosis, Chlamydia, sperm DNA fragmentation; she had done any test you can
name ! And after each test done , they felt more and more helpless, because
each result was normal. “Why can’t I get
pregnant, doctor, if everything is normal?” was her lament.
It amazed me on how little she had learnt from her visits to
so many doctors.
She had to be reminded that the kind of answers we get to
our questions depends on the quality of question we ask. Instead of asking
about “What is the problem? Why aren't I getting pregnant?”, her question
should have been – “ What can I do to get pregnant?” People only care about
solutions – no one cares about problems.
By asking a better question, one gets a better answer! She
had to be made to understand about this new perspective and I had to guide her
through this viewpoint. The important thing was not her reason for infertility– the only thing which mattered was how we could go about fixing the problem.
Everyone knows about GIGO: Garbage In, Garbage Out. If the
only question you keep asking is “What’s the problem?” then you will end up
wasting a lot of time, money and energy in order to identify the problem. Most
of the diagnostic labels that we use in reproductive medicine are inaccurate,
unreliable or even completely wrong. A few years ago, we had wrongly diagnosed
many patients for having an “inadequate luteal phase” and even treated them for
the problem. We realized later, with retrospection, that not only there was no
such condition, that we also did a major disservice to the patients by treating
them for a non-disease.
It brings great grief to my heart to see so much time and
money being wasted by infertile patients and their doctors in pursuing a pointless
diagnosis. Is it the endo, doc? Could I have antisperm bodies? These are futile
questions !
Thus, after an unsuccessful IVF cycle, the first thing a
patient asks me is – Why didn’t I get pregnant? (Ironically, none of the
patients who do get pregnant after IVF ever bother to ask - Why did I get
pregnant? We are not in a position to answer either of these questions reliably
- more often than not , it is a matter of chance as to which cycle works !)
The correct thing to ask after a failed IVF cycle would be
to – What should my next course of action be ? Most of the times, the best
option is to repeat the IVF (In Vitro Fertilization) cycle. You may feel it’s like
buying a lottery ticket- there is no compulsion to do so, but if you do not
buy, you do not win either! And the more often you buy, the better are your
chances of winning!
The ideal question to ask would be- What would be the next
step? It is a good idea to enumerate all the possible treatment options-
starting from stopping treatment and remaining child-free; adopting, repeating
the IVF cycle, doing the IVF cycle at a new clinic; or using third party reproduction.
Once that is done, you can then eliminate the options that you would not be
willing to consider, so that you are left with the options that you are willing
to explore. You need to think about all these options carefully until you come
to a decision as to which option would suit you the best.
More often than not, after using this approach , you will
find that the absence of alternatives makes decision making easy, and you can then
plan your next step and navigate your path through the infertility maze with
much greater ease!
POSTED BY DR.MALPANI
Articles:
- Dr Malpani - Patients with poor ovarian reserve - flogging a dead horse ? (drmalpani.wordpress.com)
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