Managing Patient’s expectation in IVF treatment

By Olumuyiwa Eleshinla

In vitro fertilization (IVF) is a medical procedure in which an egg is removed from the woman’s ovaries and fertilized with sperm in a laboratory. The fertilized egg, now called an embryo, is returned to the woman’s womb to develop.

This procedure was first successfully carried out in 1978 by Drs. Steptoe and Edwards of Oldham General Hospital in the UK after over two decades of research, which led to the birth of Baby Louise Brown, the world’s first ‘test tube’ baby.

This ground-breaking achievement led to a surge in the establishment of fertility centres as well as the development of more sophisticated techniques such as IUI (inter uterine insemination), PGD (Preimplantation Genetic Diagnosis), and ICSI (Intracytoplasmic Sperm Injection). These new techniques make the path to parenthood easier for more people struggling with infertility.

In Nigeria many couples attempting to conceive seek help from fertility centres as a last resort, having passed through several phases, from denial to seeking for spiritual intervention.

The power of prayer, however, cannot be disregarded and several couples who experienced difficulties in getting pregnant and sought spiritual agency have succeeded in conceiving children without medical treatment.

These examples give false hope to the vast majority who do need medical attention and when they do turn to fertility centres, their condition may have deteriorated, leading to higher costs to rectify the problem.

Most patients who seek help from fertility centres are unaware of the possibilities and limits of fertility treatments. Cultural taboos in many areas place an injunction on certain treatment options such as surrogacy and ovum donation. The more extremist religious sects prohibit their adherents from seeking any form of medical treatment for infertility.

Time is a major factor that affects the outcome of fertility treatments. As a woman ages, the quantity and quality of her eggs reduces, lowering her chances of conceiving.

In many instances a woman may have spent several years searching for a spiritual solution to resolve her fertility issues before turning to fertility centres by which time it may be too late to guarantee a positive outcome. In addition, many men are reluctant to test the quality of their sperm from a false sense of machismo and often refuse to accompany their partners to fertility centres, unaware of or denying the fact that male factor infertility is responsible for the failure to conceive in many instances.

Although treatment options are available to address these issues such as
Fertility assessment which is a series of tests and examinations to evaluate the fertility status of individuals or couples wishing to conceive, determining potential obstacles to natural conception.

In Vitro Fertilization (IVF) A medical procedure where an egg is fertilized by sperm outside the body, in a laboratory dish, with the embryo then transferred to the uterus for pregnancy.

Pre-implantation Genetic Testing (PGT): A technique used in conjunction with IVF to test embryos for genetic disorders or chromosomal abnormalities before transferring them to the uterus.

Cryo-preservation which is the process of freezing and storing cells, tissues, or embryos at very low temperatures to preserve them for future use, commonly used in fertility treatments.

Cultural and religious injunctions as well as the high costs associated with the deployment of more sophisticated techniques conspire to discourage potential parents.

Managing patient expectations in fertility treatments, therefore, is of paramount importance and is crucial for ensuring a positive patient experience.

Open communication is essential to the process. Patients should be encouraged to openly express their hopes, concerns, and expectations. The fertility specialist should lend an attentive and empathetic ear to their questions and concerns and set realistic expectations by explaining the range of possible outcomes and potential challenges they may encounter during the treatment process.

The fertility specialist has a duty to provide patients with accurate and detailed information about the fertility treatment process, success rates, potential risks, and limitations. Care should be taken to fully explain the different steps involved, potential outcomes, and the factors that can impact success. Emphasis should be laid on the fact that fertility treatments are not guaranteed to result in pregnancy and that multiple cycles may be necessary.

Reliable and accurate success rate statistics from reputable sources, such as research studies or fertility registry data should be shared with patients. This will help them understand the chances of success and provide a realistic perspective.

There is no ‘one size fits all’ treatment plan in infertility treatment. Individualized treatment plans should be tailored to fit each patient’s unique circumstances, medical history, and fertility issues. Specific factors that may affect their chances of success, such as age, underlying medical conditions, and lifestyle choices, should be considered to help manage their expectations accordingly.

Realistic timelines should be set by the fertility specialist. Patients need to be informed about the typical duration of the treatment process, including the time required for testing, treatment cycles, and waiting periods. They must understand that achieving success will take time and patience.

Ongoing communication with patients must be maintained throughout the treatment process, providing updates, explaining any changes in the treatment plan, and addressing any concerns or questions that arise. This helps patients feel involved and reassured.

Bridge Clinic’s Counselling service provides comprehensive patient education support through emotional management of clients, health education, medication adherence, behavioural health education, preventive care as well as personalised counselling service tailored towards addressing specific needs, concerns and circumstances of each patient.

The importance of providing emotional support cannot be overemphasized. The fertility specialist must acknowledge and empathize with the emotional toll that infertility can have on patients. Psychological support, counselling services, or referrals to support groups should be offered to patients to help them cope with the emotional challenges associated with fertility treatment.

For instance, Bridge clinic’s counselling service includes but is not limited to Post Appointment consultation, Post Standard investigation review, Surrogacy counselling, Gamete donation counselling, Single women counselling support, Special- circumstances -causing -high distress and Staff support.

A multidisciplinary team, including fertility specialists, nurses, counsellors, and embryologists, should collaborate to provide comprehensive care and support to patients. This ensures that patients receive well-rounded and coordinated care, which can help manage their expectations effectively.

Overall, managing patient expectations in fertility treatments requires clear communication, individualized care, and empathy. By providing accurate information, setting realistic expectations, and offering emotional support throughout the process, healthcare providers can help patients navigate the journey to parenthood with a better understanding of what to expect.