Chapter 6: Efficacy

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Chapter 6: Efficacy by Mind Map: Chapter 6: Efficacy

1. Conclusion

1.1. Facts of efficacy must be Standardized according to age group, # of attempts and of embryos implanted (type of infertility?)

1.2. Success rates for these technologies are not good anywhere in the world. But they may be particularly bad in Third world locations, such as Egypt, however many clinics aren't willing to admit this "jeopardize" generation and maintenance of hope

1.3. Rate of ‘take-home babies’ is low – IVF and ICSI are not procedures with high success rates

1.4. The ‘objective facts’ of efficacy are social constructs.

2. Realities of Success and Failure

2.1. Clearly test-tube baby making in the best IVF centers is a low-odds proposition

2.2. Proliferation of many new, "low-quality" IVF centers, the % of success at other Egyptian clinics is likely to be even lower (technical difficulties)

2.3. Many infertile women experience the devastation of prior IVF/ICSI failures, which depresses IVF clinic staff too

2.3.1. Multiple repeaters routinely couch their acceptance of failure in religious terms

2.4. Difficulty accessing drugs, repetition of trails cause psychological distress and a toll on their pocketbooks

2.4.1. Some trials succeed while most do not

3. Positioning Egypt in the Discourses of Hope

3.1. Western anthropologists and sociologists have characterized the NRTs as "hope technologies,"whereby hope is commodified as part of a "marketing tool" by which IVF doctors " sell hope and persistence"

3.1.1. Invoking inflated success rates along with God's will

3.1.2. IVF patients ardent desires for success, along with religions convictions that their success is ultimately in God's hands, seem to make them less critical of inflated efficacy claims

3.2. Infertile couples are more than willing to to talk about the many problems they encounters; prohibitive costs, concerns about laboratory mixing of bio genetic substances, and supercilious physicians who mistreat them

3.2.1. But rate inflation, Surprisingly does not present itself as a major concern = patients adopt "nationalistic stance"

3.3. Egypt maintains a privileged regional position, even on a global stage IVF patients believe success rates are just as good or even surpass rates in Western world.

3.3.1. Patients and Doctors place their hopes in God, who "rewards" those have demonstrated their patience and faith during long periods of adversity

4. The Egyptian Game of Inflation

4.1. Quality of care in IVF Egyptian clinics is quite variable:

4.1.1. The poor quality of care diminishes success rates is something IVF providers acknowledge

4.1.2. Most IVF providers are engaged in a deceptive "game of inflation," or whereby lower-than-expected rates are reshaped, to appear more potential

4.2. Game of Inflation is the result of Unhealthy competition between IVF clinics reporting success rates

4.2.1. Lack of an agreed-upon definition of what constitutes a successful pregnancy among IVF clinics

4.2.1.1. Pregnancy is determined and recorded (“biochemical pregnancy” is less accurate than "ultrasound-confirmed" and birth of babies)

4.2.2. Attempt to inflate success rates by eliminating all women age forty and older

4.2.2.1. Problem can be solved by braking rates by age

4.2.3. Introduction of ICSI at some at some centers= significantly lower success rates (rare)

4.2.4. Lack of uniform standards for informed consent

4.2.5. Lack of uniform standards for record-keeping = leading of lacunae of statistical info within centers and industry

4.2.6. Lack of any form of effective regulation in centers on a national level

5. The (In)efficacy of NRTs

5.1. Private ART deals with the neocolonial reliance on imported European consultants who may have little interest in middle-eastern women

5.2. "Scientific dishonesty"

5.2.1. Unnecessary and iatrogenic surgeries that are a common cause of tubal infertility

5.2.2. Nonspecializing physicians who "compete" by dissuading them from trying IVF

5.2.3. IVF physicians who attempt to entice patients with grossly inflated claims of success

5.2.4. Overarching lack of regulation of the private IVF indstry

5.3. 4 factors affecting NRTs success rates:

5.3.1. Characteristics of patients (MOST IMPORTANTLY WOMEN'S AGE) and type of infertility = fertility in women declines in mid-thirties using their own eggs becomes a rough boundary

5.3.2. The number of embryos transferred to a women's body during a treatment cycle, some physicians are willing to "hyper stimulate" a woman's ovaries to ensure larger # of eggs (quality of drugs)

5.3.3. Repetition, the need to repeat IVF or ICSI several times. Fewer attempt cycles, fewer success (expensive treatments)

5.3.4. Some calculations inflate the degree of success (clients/patients are not provided with accurate data on efficacy)

5.4. Success rates are affected by the very quality of care at an IVF center whether "a program has qualified experienced personnel and track record open to the public scrutiny"