Do Doctors Wait for Any Patient to Come Back?

By Dr. Avanthi Vellala

I’ve been thinking about how to write this one. Because this story doesn’t have an ending yet. And I’m not sure when it will.

She was 28 when she first came to me. PCOS. Irregular cycles. Hyperandrogenism. Behind her already multiple failed OI cycles, two failed IUIs, a Diagnostic hysterolaparoscopy with PCOD drilling, one more IUI after that. None of it had worked.

We moved to IVF.

Stimulation went well. We expected 16 eggs, retrieved 18.

His sperm DNA fragmentation index came back at 60% very high. So we had planned TESA(surgical sperm aspiration directly from testis) at egg pickup. The numbers were good, but the quality wasn’t.

And then we hit the wall.

Only seven were mature. ICSI done. Five fertilised.

Of the five fertilised eggs, three cleaved, two arrested early. One day 6 blastocyst was frozen. Poor quality.

This is one of the harder things to explain to a patient that PCOS can be deceptive. It gives you numbers. Sometimes a lot of numbers. But quantity and quality are not the same thing. In some PCOS cases, even when we retrieve many eggs, the embryos simply don’t form the way we need them to. And on top of that, here we had both egg and sperm quality working against us.

I advised a pool up cycle. We added antioxidants, changed the protocol, changed the injections. Waited a month.

Second cycle. We expected 16, retrieved 21. Fifteen mature. The numbers were better. We were cautiously happy.

For the sperm, we split the eggs. Half fertilised with frozen TESA sperm. Half with microfluidics on fresh ejaculate, a sperm selection technique specifically used in cases of raised DNA fragmentation, to pick the best available sperm and improve embryo formation. We added calcium ionophores at ICSI to help with fertilisation.

We did everything we could think of.

On day five, two blastocysts. Average to poor quality again.

We transferred the two best with strong pregnancy support. It failed.

They accepted it without much question. That’s the thing about this couple they’re soft spoken. They came with high expectations, which I understood and I tried to meet. I didn’t make any false promises but I wanted to deliver. I really did.

He works in IT. He’s been quietly funding all of this, the treatment, the EMIs, the family. He’s quite emotional by nature but holds it in. The kind of man who doesn’t let it show until he can’t anymore.

She appears quite strong. But she suffered from depression and anxiety during her high school years. That history doesn’t just disappear it lives underneath everything. A fertility journey like this one presses on those places.

My team has stayed in touch with them. They want to try again.

They're taking the time they need. And when they're ready, I'll be here.

I want to try again. I want to get them a different result. I’m not promising anything. I never do.

I’m hoping to see them walk back through my door.

So do doctors wait for patients to come back?

This one does.