Hope: the Double Edged Sword

January 26, 2014Carole 1 Comment »

I just finished reading this article in Elle, “$47,000 Dollars Later, I have no baby: The IVF Scam”.  The author Ali Margo, at 43, has finally given up hope that she will ever have her own genetic child and feels, well, robbed.

I also read this rebuttal from someone who works for one of the major clinics that said basically, well, you shoulda known the odds were against you. The information is out there.  This author then reassures Ali  that hope is a renewable resource. The rebuttal article then goes on to make an important point. IVF services do not guarantee a child, no matter how much you pay. Sometimes, all you get is a better understanding of what you are up against and more information to weigh as you consider other routes to parenthood. 

I cringe when I read all the “Just be Hopeful ” posts from well-meaning folks. It seems so harmless and even beneficial. Hope is always a good thing, right? Well, sometimes it is good if it allows you to keep going at all but it is bad if it allows you to keep going down the wrong road.

Part of what health care providers sell  to patients is hope. Here’s a treatment that might work. Have hope. Feeling optimistic may by itself have some therapeutic properties so I am not saying that an optimistic outlook does not have its uses- in moderation. The gambling addicted always have hope; that’s what keeps them gambling. At some point, cold hard analysis of your situation and your probability of success have to come into play –hopefully before your are bankrupt and divorced.

ASRM even put out an ethics statement about when and under what conditions, it is  ethical to offer services when the probability of success is very poor or futile.

They defined poor prognosis patients as those having a 1-5% chance of pregnancy and futile prognosis patients as those having  less than 1% chance of pregnancy. A 43 year old woman  who is trying to have a child with her own eggs certainly falls into the poor prognosis, if not futile category.  The ASRM recommendations to doctors boils down to this:

  • It is ethical to refuse treatment in these  poor prognosis/futile cases. It is ethical to refer to someone else who will treat.
  • You shouldn’t refuse to treat  a patient to protect your pregnancy rates.
  • You shouldn’t treat futile patients just to make money off of them.
  • You can treat these patients if they ask you to–but only if you explain the risks, benefits and fully inform the patient of the very low chance of success.
  • These conversations about probability of success should come at the beginning of the treatment relationship.
  • Clinics should use evidence-based medicine (eg. science) to identify best practices for treating poor prognosis/futile patients, and should refer patients to other clinics that may be providing the latest treatments if they can’t provide them.
  • Decisions to start or stop treatment should be made with patients and treatment plans should be revisited and revised with the patient’s input.

Obvious, right? The best clinics do a good job of this. Others struggle with it.

It’s so much easier to say “yes” to a poor prognosis/futile patient than “no”. They don’t get mad at you- at least not at first. Reasons I have heard as to why the lab is doing a hopeless IVF case: ” They’ll just go down the street to have it done; we might as well do it here”, “I don’t want them to lose hope”, ‘They need to try this at least once to understand it is hopeless” , and my favorite,  “They have insurance”.

So be somewhat skeptical of hope. It does not always benefit you.  What does benefit you is doing some research into which practices have the best success rates for patients just like you (your age, your diagnosis). When a treatment doesn’t work, ask your doctor to quarterback the procedure. What are the major factors he is battling? What can be done differently next time? What are the other options that might work better–even ones he doesn’t provide? And always ask about your probability of success in relation to  your treatment costs. It may be time to take off the rose-colored glasses and put on your green accountant shades to analyze risk vs benefit to make the best choices for yourself.










© 2014, Carole. All rights reserved.

One response to this entry

  • Kelly Says:

    Wasn’t hope the last thing remaining in Pandora’s box? Hope is exactly a double edged sword. Reading the Elle article, I just thought, you’ve got to be kidding me, it’s rare for women to get pregnant with their own eggs at 43, but the author doesn’t state if donor eggs were brought up and if she refused to try with her own eggs. It may have been less expensive to go straight to a DE. Women need to be informed that those celebs in their 40’s are using eggs from women in their 20’s to have babies & egg quantity & quality decline rapidly.

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