Thursday, December 06, 2012

Infertility doctors and irrational treatment

Infertility doctors can be very irrational at times. When patients approach them , they often forget that the real desire of the patient is to have a baby ! They follow age old irrational treatment protocols which are time-consuming, patient-unfriendly and can actually delay the process of achieving a pregnancy. This can end up wasting the patient’s precious fertile years.

Here are three examples of how infertility doctors will treat patients with interventions which actually end up reducing their fertility, rather than helping them to have a baby.

In the recent past, many doctors used to test the woman, for the presence of anti-sperm antibodies when they came for infertility treatment. It was believed that anti-sperm antibodies would kill the sperm and were responsible for immunological infertility. The presence of anti-sperm antibodies in women was treated by asking the couples to use condoms while having intercourse. It was hypothesized that,exposure to sperm causes the woman to create anti-sperm antibodies;and therefore condom use (for at least 6 months ) would prevent further exposure of the immune system to the foreign antigens present on the sperm. This strategy was believed to reduce the anti-sperm antibody levels in woman which would help her to conceive once the condom use was discontinued. However , we now know that it's very common to find these antibodies in fertile women as well; and anti-sperm antibodies are unlikely to play a significant role in causing infertility. “Treating “ them just wastes time !

To cite one more example of infertility doctors’ irrationality - birth control pills are used to regulate the irregular menstrual cycles in women with polycystic ovarian disease. Women with polycystic ovarian disease do not ovulate and hence they lack regular menstrual cycle. If they do not ovulate that they cannot get pregnant ;and if they want to have a baby , the focus should be on inducing ovulation. However, a lot of doctors will spend 3 to 6 months on regulating the menstrual cycle with birth control pills, before actually starting fertility treatment. This is based on the illogical old belief that if the cycle becomes regular they will automatically start ovulating . However, a birth-control pill will not correct the root cause of the problem – it just suppresses the PCOD temporarily . Once she discontinues BCP , her hormonal imbalance returns . To make this approach more “ scientific “, some doctors will measure the FSH and LH levels in these women; find high LH levels , as expected; and then tell the patient that they need to reduce the high LH levels back to normal by using birth control pills, in order to help them to get pregnant . This just reinforces the flawed belief that it’s important to regularize the hormone levels before initiating pregnancy. This makes absolutely no sense . While putting these women on birth control pills will suppress their LH levels and will regularize their cycle while they are taking the pill, it will also prevent them from getting pregnant as long as they are on the pills. When they stop taking the pills , their LH levels go back to being high and abnormal, because the underlying polycystic ovarian disease has remained untreated !

Another problem we encounter today is the irrational treatment approach followed by some doctors in the management of infertile women with endometriosis. Women with endometriosis who want to get pregnant are treated with GnRH analog depots such as Zolodex and Lupride  by many infertility specialists.  These GnRH analogs switch off the pituitary for protracted periods of time. They create a pseudo-menopausal state,  by suppressing the estrogen and progesterone levels by switching off their production of FSH and LH. While it's true that low estrogen and progesterone levels will cause the endometriotic lesions to subside, it is also equally true that they cannot get pregnant while undergoing this medical therapy. This medical therapy only achieves a temporary suppression of the endomteriosis deposits. When they stop taking these medications, the endometriosis comes back because the estrogen and progesterone levels rise again to the normal range. The use of GnRH analogs leads to enormous suffering in these women because of menopausal symptoms due to estrogen deprivation. Women who undergo such treatment lose faith in doctors because the treatment is not only time-consuming , it also fails to help them in realizing their dream.

Other examples of irrational therapy includes the use of antiviral therapy to treat women with elevated TORCH antibody levels ;as well as the use of a wide variety of medications to treat anti thyroid antibodies ; and elevated NK cells. None of these “treatments” have been shown to enhance fertility – all they do is to waste the precious fertile years of the patient ! Patients need to gain enough knowledge of these facts if they want to protect themselves against such kind of irrational treatment approaches still followed by some gynecologists . Remember, your goal is a baby and you need to make sure your doctor’s goal is the same as well ! A good doctor  works with you in helping you to achieve your dream of having a baby quickly, rather than concentrating on “treating” the numbers in your lab results !

2 comments:

  1. This post made me felt, since doctors patience is getting down currently with patient.

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  2. An insightful post indeed. Many infertility doctors don't realize that what those who are going through this agonizing period is understanding and attention. Like you mentioned, these doctors are only refusing to grow with the times. Anyone going for an infertility treatment should seek out information like these first before going for the treatment so they can also help themselves.

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