In fertility practice, the IVF plan discussed at the first consultation is not always the plan a couple eventually follows. Dr Angana De, Fertility Specialist, Birla Fertility & IVF, Siliguri says a patient may respond differently to stimulation than expected, fertilisation may be lower than anticipated, embryos may need to be frozen instead of transferred, or another cycle may require a different approach. When the situation changes, the conversation around consent also needs to change.
IVF is a series of decision making, It involves several stages and decisions, from ovarian stimulation and egg retrieval to fertilisation, embryo culture, freezing and embryo transfer. For some couples, treatment may continue for over several months or involve more than one cycle.
This is why informed consent should be viewed as a continuous process rather than a one-time signature.
What changes during a longer IVF journey?
The first is the treatment itself. A subsequent cycle may require a change in medication or fertilisation method, such as the use of ICSI. A fresh transfer may be postponed in favour of a frozen embryo transfer. In selected cases, genetic testing may also be discussed. Each new decision has its own purpose, limitations, risks and alternatives, which should be explained before proceeding.
The second is the patient’s perspective. After an unsuccessful cycle, miscarriage or months of treatment, couples may reconsider how far they want to continue, whether they want another cycle or how they wish to manage embryos in storage. Decisions that seemed straightforward before treatment may feel very different later.
Long treatment journeys can also bring information fatigue. At the beginning of IVF, patients receive a large amount of information about medicines, procedures, timelines and outcomes. Revisiting important decisions gives them an opportunity to ask questions again with the benefit of what has happened during treatment.
In India, ART procedures require informed written consent. But meaningful consent is more than completing the required documentation. Patients should understand what is being recommended now, why the plan has changed, what alternatives exist and what happens if they choose not to proceed.
Repeated consent conversations are therefore not unnecessary repetition. They reflect a simple reality: IVF can evolve, and consent should evolve with it. Good fertility care is therefore not only about carrying out procedures safely. It is also about ensuring that patients remain informed participants in their treatment, with enough time and clarity to understand their choices before moving forward.
