I was really knocked for a loop when I read about getupgrrl's consultation with Dr. Third Opinion. To find out that the last three years of trying to get pregnant, a few IVF cycles, and a miscarriage were all for nothing is just too much.
Many of the commentators are advising her to sue Dr. Love, but I think that's not the point (although I think her insurance company should sue him, since money is the point for them, and while they're at it they should get grrl's out-of-pocket costs recouped for her). If I were her, I think I'd file a case with the medical licensing review board and begin the process of attempting to get his license revoked for incompetence. Unfortunately, I think it's systematic incompetence as much as his own personal incompetence.
I recently got into an argument with some women I really respect about whether or not insurance should cover assisted reproductive technologies. I said it should in all cases, and the other women thought this was wasteful lunacy. These women, and I think the majority of the public, see ART as one single issue: a 40-year-old career woman who decides she wants a baby, who then does IVF cycle after IVF cycle in a desperate and misguided attempt to have a baby.
I think the unfortunate truth of ART is that there's a tiny kernal of truth in that assessment. Not with the woman--most of the women I know going through ART are going through it for reasons they had absolutely no control over. (Let me also put out there that the majority of women who go through ART have male partners who are equal participants in as much as possible, but ultimately the physical and emotional stress, and therefore the major decision-making, comes back to the woman, so I'm only talking about the woman here.) And not with the "desperate and misguided" part on the part of the woman. I think the real problem with ART is that the technological cart came before the horse and we haven't caught up with it yet.
We have all these amazing techniques now--IUI, IVF, ICSI, PGD. But in so many cases, they're not being applied correctly. The system completely breaks down during the initial diagnosis stage. Almost every woman I know who's gone through ART has been told "Let's do three cycles of IUI, then if that doesn't work we'll switch to IVF." It's true for women who have PCOS, women who have "unexplained fertility," partners with low sperm counts, even women who get pregnant easily on their own but miscarry.
That's like the old stereotype of the student health center from my college (I'm sure it was the same at yours). You'd come in complaining of any ailment in the world--sprained ankle, bee sting, exam stress, sinus infection--and they'd talk to you about going on the Pill. (My brother once went into his student health center when he hurt his foot and the nurse on duty asked him to take a pregnancy test. He got a BFN.)
It's as if the doctors don't have any idea what's preventing women from getting pregnant, so they just apply the most recent technologies they have and hope that one of them works. Statistically, a certain percent of these women will get pregnant from the "3 IUI then IVF" method. I wonder how different that success rate is from the percent who would get pregnant in that same time frame without ART.
It seems to me that reproductve endocrinology needs to take a step back and focus on diagnosis instead of coming up with more and more technology to blindly apply. If we could come up with more effective tests to pinpoint exactly what was causing the problems conceiving before doing any treatment, we would have better success rates at achieving pregnancy with less waste of medical resources, money, time, and emotion. What if you knew that the only way to get pregnant was IVF with PGD? What if you knew that you could never carry a baby and that your two choices were a gestational surrogate or adoption? What if you knew that you had a blood clotting disorder that needed to be fixed or else you'd continue to miscarry? What if you knew?
I feel one of the main barriers to this diagnosis-before-treatment approach is the culture of the medical system here in the US. Doctors are put through so much hazing and other crap on the way to becoming doctors that the only way to survive is to see yourself as a hero. How many women are told, in their first meeting with a new RE, "I can get you pregnant. Definitely."? They don't say, "Let's really get to the bottom of what's preventing you from getting pregnant/staying pregnant. Once we've really investigated it, then we can decide what to do about it." REs are trained to be saviors, not investigators. And that ends up hurting patients (like grrl) but it also ends up hurting the doctors and the profession itself, because the ART industry is just limping along faking it.
Unless reproductive endocrinology as a profession/industry can take a step back and become more diagnosis-oriented, there is going to be a crisis in the industry within the next few years. Their success rates won't be any better, but more money will be spent. Neither the insurance companies that do pay, nor the patients themselves (who pay in money, but mostly time and emotional and physical pain) will put up with it. I hope that the industry can apply some of the standards that business does to really pinpoint the weaknesses in the system and expend the time, energy, and research to fill in the gaps. And then I hope that approach can filter down to GYNs, who need to be more educated about infertility in general, so they stop thinking (and saying) things like, "The Pill preserves your fertility" and "Don't worry about that PCOS. It won't have any effect on your trying to have a baby."
I'd like to think that Dr. Love is the only incompetent RE out there who sold out a woman because of a misdirected attempt to help her. But I think it's the whole industry that's responsible. It's our whole culture. We want answers; we don't want careful consideration of the question. We need to step back and ask more from ourselves and from our doctors and researchers. We need to demand to know why something is broken, and get angry when all they offer is a pill that "might" fix it.
But I still want Dr. Love to lose his medical license.