Thursday, October 02, 2014

Overtesting versus thoroughness - more is not always better in IVF !

When an IVF  doctor orders lots of tests, most patients are very impressed. The feel that this doctor is being extremely meticulous and thorough , which means he is doing his best to find problems and solve them. They believe this approach will maximize their chances of getting pregnant , and they admire doctors who routinely do a series of tests ( such as hysteroscopy , TB PCR testing, NK cells testing, sperm DNA fragmentation and so on) . The more expensive the tests, the happier the patient is. This is especially true if the doctor tells them that they need to send the sample overseas for the test ! This just confirms that this doctor is extremely sophisticated and is using the latest cutting edge technology to help them to have a baby. Doctors will often play a game of one-upmanship to demonstrate to patients how they are better than the rest – and the more esoteric the test, the easier it is to play the game and score points !

There is still an aura of mystique about medical testing , and patients are awed by reports which are full of medical jargon. After all, any doctor who can makes sense of so much gobbledygook must be a real expert !

Doctors are more than happy to order more tests – after all, ordering tests is profitable for them . Not only do they get a cut from the lab fees ( which the lab offers to lure them into sending more tests) , it’s also a mathematical certainty that the more the tests you order , the more the abnormalities you will find ! This now gives the doctor an excuse to order  even more tests ; provide additional “  treatment”; and refer the patient to colleagues and specialists. This means the patient ends up spending a lot of money even before they actually start the IVF treatment cycle ! Some patients end up wasting over six months in  testing and consultations – and the cost of these is nearly as much as that of the IVF cycle. However, since the costs are incremental, they end up spending  a pretty penny, in bits and pieces . By the time they realize how much time and money they have wasted, it’s too late to do anything about it, as they are now committed.

Patients need to remember that quantity and quality don't always go hand-in-hand . Overtesting is often unnecessary – and the only person it helps is the doctor because it helps to increase their profits. Lots of these tests yield abnormal results , which are false positives and have no bearing on the patient’s fertility at all. Most don’t change the patient’s treatment options , which means a lot of this testing is extremely wasteful . Because insurance companies don't pay for IVF treatment , this hard-earned money comes from the patient's pocket . This means that not only does the patient waste a lot of valuable time and money on these unnecessary test results , they also spend so much on “treating” the so-called abnormalities , that they often cannot afford to do more than one IVF cycle .

The list of wasteful tests is extremely long – and varies depending upon which part of the world you are in. Patients need to get back to basics and push back when doctors order too many tests . Remember that IVF is pretty basic straightforward treatment – all we are trying to do is to achieve in the lab what is not happening in the bedroom . All we need for IVF is eggs, sperm and a uterus !

It's possible to overcomplicate this by doing a lot of fancy tests - for example , for checking sperm quality by doing " sperm function tests" , or testing for  whether the endometrium is receptive or not by doing an "endometrial receptivity assay" . While these tests make theoretical sense, they should be used only in a research setting, because we still don’t know if they are clinically useful or not . A lot of these tests are experimental and unproven . Most do not affect pregnancy success rates or treatment options , and if your doctor insists on doing lots of tests , you should definitely get a second opinion ! Tests are not always as harmless as they seem !

Not sure if the tests your IVF doctor is ordering are needed or not ? 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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