The Fertility Journey

“When the facts change, I change my mind - what do you do, sir?”

― John Maynard Keynes

“I’m getting a lot of conflicting information.”

—Approximately all of my patients

Embarking on the fertility journey is a little bit like grad school: one very long research project. Each doctor gives a different recommendation, preferring one protocol or another. As a layperson, this is understandably confusing, especially with some proponents of “Evidence Based Medicine (EBM)”, painting any and all alternatives with a coating of snake oil. This idea, that conventional medicine is based on evidence, whereas complementary medicine is not (and also they’re gold-diggers), is a ubiquitous and strongly help belief, which I enjoy challenging. The way medicine is practised is actually really complex.

Each doctor has their own clinical expertise, their own experience, and thus their own unique treatment methods that go beyond simple differences in clinical style. There are many ways up the mountain. And typically when protocols are modified, it’s because new research has spurred a change. 

However, something I have noticed is that it’s not always research. There are several reasons why a doctor might choose a treatment plan. Sometimes they review their own stats or do case studies, review files, consult with trusted colleagues, or make wise observations and try new things. Sometimes, thankfully, they even use their intuition. We all do this: make observations, deduce, draw conclusions, and conduct ourselves accordingly using all the evidence of our senses. It’s an innately scientific process. This is not only the case with modern medicine. In my Traditional Chinese Medicine practice, I also change protocols based not only on jewels of wisdom written in ancient texts, but on research, both clinical and observational trials, and also my own knowledge established over many years of practice. 

The concept of evidence-based medicine (EBM) is not a new one. The idea has been around for over a century. The notion that clinical protocols should be based on facts seems obvious, and of course everyone can agree on that. A strictly EBM approach has an obvious advantage: it meets the need of a large entity, such as a health authority, to implement standardized protocols across all platforms in the hopes of benefiting the largest number of people with the least amount of confusion, time, and cost.

However, the “facts” are not as clear-cut as we might hope. Protocols for “best practice” are established on population-based research. Opponents suggest that perhaps these protocols do not represent the needs of individual patients, expounding instead a patient-centred approach (sound familiar?). After all, the vast majority of research is done on white adult males, so understandably critics of EBM question the broad applicability of population based protocols. Many doctors and researchers in the field propose the idea of Cultural Competence in Medicine (CCM), which aims to incorporate individual circumstances and preferences into clinical decisions. Ultimately, the goal is to integrate these two concepts.

Fundamentally, despite all the nuance, my primary goal as a medical practitioner is not different from other disciplines: to heal, and that is a massive responsibility. When someone comes to me for help, puts their trust in me, believes what I tell them, follows my advice, regards me as an authority, I take that seriously and I’m not alone on that front. We are a well-intentioned bunch. In all my years of practising, I have never met a single practitioner who doesn’t ask themselves regularly if they are giving the best care possible. In fact, far from gold-digging, many of my colleagues share that it took them their first full year of practice to feel comfortable accepting payment from their patients. 

And as we learn, we are constantly confronted with new information. As a result, we change our protocols. When I suggest that a patient try the electrostimulation, for example, or when I change a point-prescription, or add cupping, or update my recommendations for diet or frequency of treatment, I have sometimes been asked “why didn’t you suggest this before?” The answer is simple. I didn’t know. New information arrives, and I integrate it into my practice. The protocols change, so the treatment you receive may look different than when you visited the clinic two years ago. 

Our medicine is a labyrinth. I’m sure any medical doctor or allied professional would say the same thing; when you know enough, reach a critical mass or base of knowledge, you suddenly realise how very little you actually know. This kind of humility is required for the clever and true application of medicine. I know less every day, but this fact does not discourage me. It’s exciting to know that each new patient, each new study brings new knowledge, protocols, practice, and healing.