Sunday, December 15, 2013

Unnecessary infertility tests - red flags that your doctor is wasting your money !


Many doctors routinely order a panel of tests for all the infertile patients they see. They do this mindlessly, as part of a "standard protocol", by simply ticking off a list of tests which the patient needs to do.

There are however, several tests that are not indicated and/or are not cost-effective if done routinely. 

1) Don’t perform routine diagnostic laparoscopy for the evaluation of unexplained infertility.
In patients undergoing evaluation for infertility, routine diagnostic laparoscopy should not be performed. In patients with a normal hysterosalpingogram or the presence of a unilaterally patent tube, diagnostic laparoscopy typically will not change the initial recommendation for treatment.
2) Don’t perform advanced sperm function testing, such as sperm penetration or hemizona assays, in the initial evaluation of the infertile couple.
Studies document that extreme variability exists among these tests, with very little correlation between results and outcomes.  They have also been shown not to be cost-effective and often lead to more expensive treatments.
3) Don’t perform a postcoital test (PCT) for the evaluation of infertility.
This is a test where the cervical mucus is examined around the time of ovulation for sperm about 8 hours after intercourse.  The PCT suffers from poor reproducibility and its predictive value for pregnancy is no better than chance.  Utilizing the PCT leads to more tests and treatments but yields no improvement in cumulative pregnancy rates.  I have not performed a postcoital test for mare than 25 years now!
4) Don’t routinely order thrombophilia testing on patients undergoing a routine infertility evaluation.
There is no indication to order these tests, and there is no benefit to be derived in obtaining them in someone that does not have a history of bleeding or abnormal clotting and in the absence of any family history.  This testing is not a part of the infertility workup.  Furthermore, the testing is costly, and there are risks associated with the proposed treatments, which would also not be indicated in this routine population.
5) Don’t perform immunological testing as part of the routine infertility evaluation.
Diagnostic testing of infertility requires evaluation of factors involving ovulation, fallopian tube patency and spermatogenesis based upon clinical history. Routine immunological testing of couples with infertility is expensive and does not predict pregnancy outcome.

So who created this list  ?

This is a definitive list, published by the American Society for Reproductive Medicine (ASRM), the leading organisation for infertility specialists in the USA !

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