Monday, September 08, 2014

Unnecessary medical tests for IVF patients



Most patients who come to us have often had extensive testing done.

They've been to gynecologists and infertility specialists and lots of them have ordered lots of tests for them. Sometimes these are the basic tests ; and sometimes these are extremely sophisticated and expensive tests .

When they come to me and I review their the file , one of the first questions they ask is – Do I need to repeat any of these tests ? In their experience, most doctors insist that tests need to be repeated again in their clinic – either because the easier tests were not reliable, or because they do not trust them.

I'm a conservator doctor and I don't like repeating tests unnecessarily , so we use certain criteria before asking for tests to be repeated. Thus, if the test has been done within the last one year from a reliable lab, we will not repeat it. Some patients appreciate the fact that we are saving them money . Others are concerned and ask -  Don’t you think you should be re-checking just to make sure that everything is still fine ?

However, when the test has been done from an unreliable lab, then I do insist that they repeat them. Some patients get upset, and feel that I am wasting their money by asking them to re-do the tests.  The problem is that as a specialist, I cannot afford to make mistakes; and while just because I have not heard of a lab does not make it unreliable, we also need to maintain quality control standards to ensure we have a high success rate – after all, this is a question of our professional reputation.

Most of these blood tests don’t cost much money, do it’s easy to repeat them. However, the problem is much more complicated when I need to review an hysterosalpingogram ( HSG) or a testis biopsy report.  It’s obviously not practical to repeat these , and this becomes a major issue when the quality of the X-ray is poor; or if the biopsy has been reported by an unskilled pathologist.

We have burned our fingers in the past by relying on other doctor’s reports, and this is an experience we don’t want to encounter again. A patient had had a testis biopsy done elsewhere, which was reported as showing normal spermatogenesis. In good faith, we accepted this report, but when we did a TESE, there were no sperm at all in his testes. We send the TESE tissue to a reliable pathologist, who confirmed that the man had complete testicular failure, which meant that the earlier pathology report was incorrect.

If the man had had slides of his earlier testis biopsy, we could have sent these for a second opinion to a reliable pathologist, to confirm that the first pathologist’s diagnosis was correct.

Similarly , when patients have had a laparoscopy done , if they have a DVD of the laparoscopy , we can review this, and confirm that the doctor’s report is correct . Thus, we had a patient who had Asherman syndrome. She had a DVD of her hysteroscopy which clearly showed that the earlier doctor had done a good job and that her problem was not treatable. Since I could review the DVD, I did not have to waste her money by repeating another DVD, and could advise her to consider surrogacy as her only viable option.

Patients need to insist on high quality documentation of their tests and treatments – whether this is a DVD of the laparoscopy; digital images of their ultrasound scans; tissue blocks and slides of their testis biopsy;  or photos of their embryos from an earlier IVF cycle. This information is invaluable, and if they demand this proactively from their doctors, it makes it much easier for me to provide them with an intelligent second opinion without having to waste their time and money repeating unnecessary tests.

Concerned that your doctor is ordering too many tests ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly ?





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