WHAT’S WRONG WITH YOU?
Most
of the patients who come to see us have already seen at least one fertility
doctor. When we ask new patients, “What’s your diagnosis?” eight out of ten of
them say they don’t know. But what is truly appalling is, neither do their doctors.
The way fertility medicine runs these days, the diagnosis is seen as almost inconsequential. Why figure out why she’s not getting pregnant, the thinking goes; we’re just going to give her drugs anyway. Or, I don’t need to know if he’s making healthy sperm in normal amounts; we’ll get enough to combine with the eggs for IVF. The general attitude is that doctors are more powerful than nature and can simply force a woman’s body to become pregnant.
The way fertility medicine runs these days, the diagnosis is seen as almost inconsequential. Why figure out why she’s not getting pregnant, the thinking goes; we’re just going to give her drugs anyway. Or, I don’t need to know if he’s making healthy sperm in normal amounts; we’ll get enough to combine with the eggs for IVF. The general attitude is that doctors are more powerful than nature and can simply force a woman’s body to become pregnant.
This
is not good medicine, and we find it offensive. Even if we could put those
things aside, however, this approach simply makes no sense. If the sperm count
is low, why not try one of the easy fixes that may be possible rather than
jumping straight to serious intervention? And if the sperm aren’t healthy, do
you really want to use them to fertilize hardwon eggs for IVF? The only
function of fertility drugs is to make more eggs release. They won’t help a bit
if the problem is bad sperm, an infection, or something toxic in the
environment. You can pump out as many eggs as you like, but if the sperm can’t
get to them or penetrate them, or the body can’t implant them or keep them once
they’re implanted, it’s not going to get you any closer to having a baby.
Fertility drugs can get more eggs released, but they can’t make a woman more
fertile.
The
first order of business must always be to find out why someone is not getting
pregnant. Roughly 10 percent of all infertile couples will not be able to find
out why they cannot conceive. The medical profession is left to shrug its
collective shoulders and explain to these people that they are something of a
mystery. They are offered ARTs, but without there being a clear idea of what is
being fixed, the outcome remains uncertain. It is impossible to determine the
best course of treatment without the crucial insight of just what is wrong.
What works for someone with blocked fallopian tubes is not going to work for
someone with a bacterial infection that’s preventing implantation, and what
works for that person is not going to help someone who simply doesn’t know when
she is ovulating or how best to time intercourse.
THE MISUSE AND OVERUSE OF IVF
The
culture among both doctors and patients has led fertility medicine in general
astray, but the effect is most glaring when it comes to IVF. We’d argue that
even in the best practices, IVF is used too often, is insufficiently
considered, and is too harshly pursued.
As in
all areas of medicine, fertility practices are getting more and more
specialized, and so we have plenty of clinics devoted solely to IVF.
Psychologist Abraham Maslow famously wrote, “If the only tool you have is a
hammer, you tend to see every problem as a nail.” These days, IVF doctors are
pounding nails just as fast and as hard as they can.
Often
women are run through IVF clinics like cattle. Doctors know their treatment
strategy before they even meet a particular patient. Doctors make themselves
too busy, then don’t have enough time to spend with each patient. Many doctors
are more concerned with their own success rates than they are with their
individual patients. Most IVF doctors go all out to convince a woman that they
can make her pregnant. Then, if it turns out they can’t, they blame it on her,
telling her that her eggs are “bad.” The big guns are always drawn first;
there’s almost never an effort to try every basic thing that makes sense for a
particular patient before proceeding to more drastic measures. It’s the rare
woman who walks into one of these practices and isn’t told she needs IVF (at
thousands of dollars per cycle). That’s like everyone who consults a
cardiologist being told that he or she needs heart surgery.
On
the flip side, many women are turned away from IVF treatment but never
presented with any other options, with the possible exception of donor eggs.
The system has mostly given up on women with high levels of
follicle-stimulating hormone (FSH)—levels that generally increase with age—on
the theory that they probably won’t respond well to the standard treatments.
Imagine oncologists refusing to treat patients who “probably” won’t respond to
cancer treatments, picking and choosing whom they will treat based on the
likelihood of quick success. Yet many fertility practices seem to have no
qualms about turning away less likely prospects. They always have one eye on
how they’ll look on paper, focusing on the stats they have to report each year
to the government, for publication. If you’ve already started the process of
ART yourself, you know just what we’re talking about. What was the first thing
you did when choosing a doctor? Bet you anything it was look up the relevant
batting averages.
All
this despite the fact that FSH on its own is not a good indicator of fertility
prospects (see page 216), although it may predict possible IVF failure. There
are many other options for women with high FSH that might allow them to
conceive naturally or prepare their bodies so that IVF may indeed work for
them. It’s become a familiar story: a woman walks into one of our offices
frantic over what other doctors have said to her, panicked that she’ll never
have a child (often because she’s been told she’ll never have a child), and
within months she needs to go back to her ob-gyn—for prenatal care.
WHAT’S THE PROBLEM?
IVF
is just the most widely used—and the most widely overused—ART. Other techniques
are overused as well—and patients are charged even more for them—including
genetic screening and intracytoplasmic sperm injection (ICSI), both of which
are discussed in chapter 25. ARTs in general have a significant physical,
financial, and emotional impact on any couple. The drugs and techniques used
pose short- and long-term health risks for the mother and the baby, on top of producing
unpleasant (if transient) side effects. Many are not covered by health
insurance. Even if they are covered, patients may bear a high proportion of the
costs out of pocket.
Psychological stress and emotional problems are
common—even when the procedures are successful, and even more so when they
aren’t. That’s in addition to the plain old physical stress of going through
the procedures. Among other things, treatment disrupts people’s personal and
professional lives. Appointments (and there are a lot of them) may be made for
the convenience of the doctors and staff rather than the patients. In any case,
they have to be squeezed into already very full lives. If you go to a fertility
clinic at six in the morning, you’re likely to see women lined up there already,
waiting to get their blood taken or have a sonogram. All in pursuit of a goal
that’s anything but a sure thing.
Even
if IVF were always carefully considered and judiciously recommended, it would
still be a mistake to rely on it as completely as mainstream fertility medicine
does, simply because the odds are so great that it won’t work. Success rates
have greatly improved since the dawn of the IVF era and are inching up each
year, but, even so, the chances of having a healthy full-term baby after one
cycle of IVF hovers at around 30 to 40 percent (and generally varies between
roughly 10 and 50 percent, depending on the age of the mother). One of the best
IVF programs in the country, for example, sends about 47 percent of patients
under the age of 35 home with a baby in any given IVF cycle. The best program
and the most-likely-to-succeed patients—and still patients get what they came
for less than half the time.
Thank you for reading the article about Making Baby Series - Part 3 : WHAT’S WRONG WITH YOU? in blog Get Natural Pregnant and if you found this article useful please bookmark this page in your web browser, by pressing Ctrl D on your keyboard.