Thursday, February 16, 2012

Hope And Encouragement During IVF: Is It Necessary?

Dear readers old and new,

The main purpose of my blog, Facebook entries, Twitter entries and All Experts advice are to give people hope; to urge them to continue their quest to have a child; to give them explanations and to help them in their quest.

I and my staff are my patient’s cheerleaders. We want the very best for them and hope and pray with them. We feel sadness when they fail and are overjoyed when they are successful. We put our hearts into them. This is a closeness that most large IVF clinics do not have the time or energy to do. This is personalized care, and it affects us because of the stresses it puts on us. Nameless, less personal and faceless care would be a lot easier for us. It would be less stress. It also would be less sadness for us, but that is not the type of care I or my staff like to give.

But today, I was criticized for something completely different. I had two patients give us feedback that we were “too encouraging” so their feeling of failure was worsened. They were angry at us for this. We were criticized for giving too much compassionate care, so that we enhanced their expectations and hence their fall when they received the negative result. I am mystified as to when good care or good service is no longer acceptable. Should we create more of a distance from our patients? Is giving hope to patients really just fueling false hope and subsequent depression? Is the anonymous factory-type care that many large centers provide, better than our approach? Is this really what infertility patients want? Are my efforts actually more destructive than they are constructive? I’d love to hear from readers of this blog about their thoughts.

As infertility specialists, we deal with a very personal issue. So personal and private that most patients won’t even acknowledge us to their friends or family. For example, I was at a B’nai Mitzvah recently for twins that, not only did I help conceive, but I also delivered. It was a celebration of the children, and there were acknowledgements of everyone in their lives, including their teachers, rabbi, friends, travel partners, etc. but, alas, there was no mention of me; the one who not only made it possible for their mother to have them, but who physically brought them safely into their world (I delivered these twins as well).

I have accepted the fact that what I do is highly personal and private. I have accepted the fact that many patients will not acknowledge me in mixed company, or in the store or on the street. Being a “fertility specialist” can have a negative impact on their standing among friends. That is certainly something that all fertility specialists have to accept. I do accept that. Unlike many other medical specialties, the praises we receive are received in private. We don’t mind that because we know that in their hearts, they appreciate the care and gift that we gave them.

It can be a bit disheartening though, at times.

Edward Ramirez, MD, FACOG


  1. Hi Dr. Ramirez,

    Great post today and, in my opinion, a very important topic. I feel receiving hope from my Dr., in any field of medicine, is really important, as long as it is realistic hope. I don’t want to be strung along, but I do feel positivity is very important. Having a positive and involved Dr. makes me less stressed and much more confident in his/her abilities. I personally chose to seek infertility treatments at a small clinic for that very reason. I had been to consultations at a large clinic and a small one and decided that a personable Dr. who can give me one on one attention and knows my name is what felt right to me. Actually, I had a consultation with you! I’ve since moved 3 hours away so obviously didn’t come back to see you, but still stuck to my decision to go to a small clinic.

    I think every one is different in the way they interact with their fertility Dr.’s. If I saw my Dr. out in public and I was with family and friends I would introduce him and show him off! And this is coming from someone who has been through several fertility treatments and not yet been able to stay pregnant more than 7 weeks.

    All in all, I say keep doing what you are doing. The patient sought treatment from you for a reason.

    Thanks for all of your helpful information!

  2. Women just want to know their real chances. Doctors can talk like they have the answer; this will work. Really, if they're lucky it's more like a 50/50 shot.

  3. Wow what a great post.I am impressed from it.

    Thanks for more sharing...........

    Laith Salma NY

  4. This is a great post. I think that maybe they are reacting to their hurt and disappointed feelings towards their negative results rather than telling your office to be less encouraging. I know that I need the encouraging words because there is so much doubt that comes up throughout treatments.

  5. Dr. Ramirez, what you're doing is amazing. Please don't let two disgruntled patients deter you from your work. Empathy and compassion are so rare these days. I'm currently doing my 4th cycle (1 Fresh and 3rd FET) and while the clinic I go to is really great, sometimes they're missing that emotional component. That is so important. The docs who treat me are wonderful and curteous and very thorough, but no one there has ever really cheered me on, encouraged me or told me not to give up. The nurses are really nice and they give great hugs, but many times as patients we look to the doctor as they know so much more and want to see that they think this could work. We know there are no guarantees, but sometimes it is so good to hear some encouragement.

    I think a great way to show someone you care, if emotional encouragement is tricky territory, is through educating them thoroughly on options that may increase their chances such as accupuncture, relaxation, mind-body work, therapy. And reinforce that education with each treatment or cycle. Things get forgotten, especially with the stress of the cycle, finances, meds etc. Keep them informed every step of the way. Most recently one of my meds, Solu-medrol, was changed this cycle to dexamethasone. No one explained why or what the difference was. It was just there on the sheet. Naturally I started worrying - why change it, what was wrong? Was this good or bad? Why after 3 cycles of Solu-medrol was it changed to Dexamethasone? I had to nail down a nurse to find out it was physician preference.
    Dr. Ramirez, please don't ever stop being the cheerleader for your patients. It makes them feel that their hard work is worthwhile even if there is a negative. It gives them a reason to go on when they're feeling despondant. It gives them the strength to pick themselves up and try again; to have hope - which I believe is a great gift. There is no price on that kind of encouragement.

  6. Hello dr Ramirez,

    I appreciate your openness to be vulnerable, together with showing care and empathy towards your pacients.

    I am also a psychlogist and, while undergoing my IVF treatment, I paid also attention to how my doctor was aware and responding or not to my psychological needs.

    I think the first psychological need I felt was to be known as a specific individual, to be recognized, to make sure all the specific details of my case were known and accounted for. and that the doctor had enough time for me.
    this did not happen completely as I had hoped for, so for many many visits I just made short summaries of my entire case history...

    the second need was to make sure my doctor was competent and made competent decisions, taking into account the specific details of my case.
    explaining to me the reasons behind his decisions and treating me as an intelligent human being who can process information is also critical for me, and that includes mentioning the success factors, the risks involved, the unknown, acknowledging the mistakes made...

    and of course, empathy and care, especially at the sad moment of failure... the reaction I received, and this determined me to change my doctor for the next IVF cycle, was " i am too tired now to make science fiction hyphotheses about why your period started one week earlier while still on progesterone"...

    so I think it is really admirable of you to give your time to unknown persons on this blog, to be there giving hope for your pacients and to make a personal bond with them. it makes you HUMAN first before being a professonal and I just wish my next doctor will be more like you...




Related Posts with Thumbnails