Saturday, July 18, 2015

Is it Really Unexplained Infertility?


Infertility is the inability to conceive, and in some couples, the exact cause is undetectable. Doctors label this condition as “ unexplained infertility” . In these couples all the investigation reports come back as normal. However, only 10% of infertile couples can be labeled as having unexplained infertility. It is also one of the most misused diagnoses by doctors and IVF specialists.

Most IVF clinics operate on an assembly line model and many doctors don’t have the time to pay individual attention to their patients. The patient will be prescribed a standard battery of tests; once these tests come back as normal; the doctor loses no time in labeling the patient with the “unexplained infertility” tag.

Incorrect Evaluation

The unfortunate part is that not all of these patients have been correctly evaluated. The diagnosis of unexplained infertility simply means that even with the current day medical technology at our disposal, we are not always able to pinpoint the reason behind the inability to conceive. Our tests and investigations aren’t accurate enough to be able to identify all the causes. However, this should be a diagnosis of exclusion.

Some Facts

There are times, when a doctor may not bother to do the exact tests that can help reach the correct diagnosis. This could be because he may not be well-informed or up-to-date with his information
At times, the town his clinic is in may not have the latest, sophisticated testing facilities. For example the blood test for AMH levels gives an indication of the ovarian reserve of the patient. Patients with low ovarian reserve have difficulty conceiving naturally and are best managed by IVF. This particular diagnosis is very commonly missed by gynecologists, and patients end up wasting a lot of time trying to have a baby in their bedroom, because the doctor has mis-labeled them as having unexplained infertility
The other aspect of this problem is that not all the causes will have symptoms or signs;  and a doctor will have to literally hunt for the right diagnosis by ordering the right tests
Similarly, the diagnosis of male infertility tends to get overlooked, because the semen analysis has not been done properly

Too much testing

On the opposite side of the spectrum are IVF specialists who will over-order tests (PCR testing for TB or tests for NK cells) in order to reach a diagnosis. Not only are many of these tests unnecessary, but they also create a considerable amount of harm as incidental findings surface in the test results. Typically, these have no  impact on the patient’s fertility; however, the doctor will then proclaim that they are actually  the cause for the  infertility
In reality, a number of these abnormal test results have no clinical significance at all, and many will be found in fertile couples too.  In one sense, her infertility is still "unexplained", but  when the patient is told that the abnormal test result  is the cause for her infertility, she is willing to accept this "diagnosis".  Her perception is that since the right diagnosis has now been made, the correct treatment can be started which will help her get pregnant.

A Different Philosophy

Our philosophy is completely different. We believe that the question should NOT be “Why is the patient not getting pregnant?” Rather, it should be “What can we do to help the patient get pregnant?” After all, no one cares about problems – we only care about results – about helping people have the babies they want! This is why we use a success-oriented approach that bypasses problems!

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

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