In Infertility/IVF treatment tests have a major role and many doctors go for a series of tests. For the doctor, it’s much easier to order a test than to talk to the patient, which means that many doctors will mindlessly order a battery of tests in order to make a diagnosis. Few patients (or even doctors for that matter) question the cost effectiveness or utility of these tests, which are mechanically performed on a routine basis.
Overtesting just makes issue more serious and wastes money, sometimes it results in more serious problems. Ordering a test is easy but implementing the intelligently is really tough. Take the simple example of presence of pus cells in the semen analysis. When these cells are examined on a microscope, they are actually sperm progenitor cells which are found in normal semen. However, they are usually misreported as pus cells and many doctors then punctually mark the man as having a genital tract infection and treat them with infinite number of anti-biotics, in terms of clearing up the infection.
The non-trustability of medical tests also leads to a major problem today. Most probably the reason can be accredited to the laboratories whose performance is marked by factors like unskilled manpower, poor quality control and outdated equipment.
Unluckily, when the infertile patients go to another doctor, most of them insist to repeat all the tests again as they do not rely on the tests of any other lab. This is very disappointing and patients end up wasting even more time, money and efforts.
Ironically, it is also true that doctors test again because patients demand to do so. This is very usual, for example, couples suffering from unexplained infertility asks doctor to keep performing the tests until the cause of infertility is not found.
Our approach towards testing our patients is to simplify tesing. We just require to test 4 things:
- and Tubes.
The semen analysis to check the husband’s sperm count and motility, after requesting him to abstain from ejaculation for at least 3 days.
The blood of wife is then tested for measuring the levels of her four key reproductive hormones. prolactin, FSH ( follicle stimulating hormone), LH (Luteinizing hormone), TSH (thyroid stimulating hormone). During the menstrual cycle, these levels vary and that’s why needs to be done between the Day 3-5 of the cycle.
We then do a hysterosalpingogram (an X-ray of the uterus and tubes) for her after the menstrual bleeding has stopped – between Day 5-7, to confirm her uterus and tubes are normal.
Then we examine the couple on Day 9 with all the test reports and review their outcomes. These three general tests allow us to confirm whether the sperm, eggs, uterus and tubes are normal or not.
Here we have mentioned some of the tests which many doctors ask from the infertile patients, which are wasteful and unnecessary according to us.
SamplingDiltation and curettage (D&C) or an endometrial biopsy (EB) for endometrial sampling
- TORCH tests.
- Doppler test
- Sperm function tests
- PCR for endometrial TB.
- Immune testing for patients with repeated IVF failures and repeated miscarriages.
Likely, as over testing can be problematic, we have also observed that under testing can also result in different problems. Thus, we have observed that many men who have been recommended to undergo IVF treatment, grounded on just a single semen analysis report, which was not normal. It is necessary to repeat the semen analysis, after the duration of 4 to 6 weeks to determine the abnormality because the sperm counts vary every time, even in normal men.
You must ensure that your doctor reads your original x-rays and scans and not only the reports, because his exposition may vary from the radiologist’s. If you have undergone the series of X-rays and scans, they should be in sequential order, so that the doctor can verify them easily.
When a test is recommended to you, must ask these following questions:
1. Why is the test being ordered?
2. How ultimate the test is? Will it be able to reveal that a condition is present or not? Or will it lead to some more sophisticated tests
3. What will the doctor be looking for in the reports of these tests or what is the purpose of the test?