Thursday, October 01, 2015

Is your IVF doctor doing too many expensive tests ?



Diagnostic tests are a vital aspect of medical practice today, and all doctors rely on these to make the right diagnosis for their patients; this helps them embark on the appropriate medical treatment. Regardless of what the medical problem, tests are a very standard component of the workup and most doctors follow a set protocol when they are treating patients.

The Tests

It’s the same when patients come in for infertility treatment, and there are a slew of tests which some IVF doctors will order routinely to evaluate all infertile couples. These can include:

Sperm DNA fragmentation test
Chromosomal study
Antisperm antibodies
Hysteroscopy
Antiovarian antibodies
TORCH tests
NK cell testing
TB PCR

A Matter of Unnecessary Testing

The problem occurs because different infertility clinics follow different testing protocols. There are some doctors who will by default order a battery of tests for every patient at the time of their first consultation and these tests are often steeply priced. There are a number of esoteric, exotic and expensive tests such as genetic tests , as well as some for immune function.

Most large clinics will follow this typical “one-size-fits-all” approach. This is because they have to ensure that the junior doctors at the clinic follow protocols unquestioningly. This is largely a part of their standardization technique, but isn’t really fair to the patients, because these tests are unnecessary for most and they end up wasting a lot of money.

How we go About Testing

However, certain doctors are very selective in their approach. They do order some basic tests for most of the couples who come to them; however if a certain patient has failed an IVF cycle, they will order many more. We do things a little differently at our clinic and order just 4 tests. These are to test the 4 key components required to make a baby - sperm, eggs, fallopian tubes and a uterus. The tests we order are:

Vaginal ultrasound scan
Semen analysis
Blood tests for FSH,LH,PRL,TSH and AMH
HSG ( hysterosalpingogram)

Are Fewer Tests Better?

There is a dual benefit in taking this route- The tests can be  completed within 10 days and can determine what the cause of the couple’s infertility is, at  cost of only Rs 10,000/- . Some patients who have heard that IVF clinics order reams of tests, sometimes wonder whether we are being thorough in our approach to their treatment. If they voice this, I tell them that their fears are unfounded and that a number of clinics will over-order  tests only because it translates into more money in their kitty.

The Patient’s Preference

The patient’s preferences also have to be taken into account when tests are being ordered. Some patients feel more comfortable with a thicker sheaf of test reports in their hands and feel that they are leaving no stone unturned in their treatment; in contrast , intelligent patients get upset if their doctor orders too many tests or if he insists that they repeat the tests from a lab he recommends. They recognize that the doctor is wasting their time and money. More is not always better !

Time for Patients to Wizen-Up

If you find that your doctor is ordering tests in a very random manner, it’s important that you speak up and ask why he is ordering those tests. Some tests can have side-effects and it’s crucial you know which ones are  really necessary and which ones aren’t. Excessive tests can distract the doctor and he will end up treating so called “abnormalities” instead of focusing on the infertility treatment itself.  In our clinic, we adopt a success based approach; we shine the spotlight on creating solutions that bypass problems, rather than on digging for them.

Worried that your IVF doctor is doing too many expensive and unnecessary tests? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you properly !

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