When infertile couples go to a doctor, they expect that he will do tests to find out what the problem is, make the right diagnosis and then offer the right treatment. I wish life was so simple !
Unfortunately it's not , because though it's very easy to do the tests, what doctors often fail to tell patients is that our tests to assess fertility have major limitations. They're very good at defining anatomy, but not good at checking for function. Thus, we can measure a man's sperm count and motility, but we can't tell him whether his sperms are capable of getting his wife pregnant or not - the only question which he is interested in answering. Remember that a semen analysis cannot tell us if the sperm can fertilize the egg or not. Similarly, we can do a HSG to find out if the fallopian tubes are open, but we can't check if the tubes are functioning or not. This is a major limitation of all fertility tests , and patients sometimes don't understand this , partly because their doctors don't bother to explain.
This creates a lot of misunderstanding , and this is why patients need to understand why the tests are being done, and what their limitations are. Thus if the sperm count is zero, we can definitely say the man can't get his wife pregnant. However, just because his sperm count is normal doesn't necessarily mean that he can get her pregnant, because the sperms may be functionally incompetent. We would actually have to do an IVF treatment cycle and document total failure of fertilization to come to this definitive conclusion. Similarly if the HSG shows the tubes are blocked we can tell her confidently, that she is infertile, but just because the tubes are open doesn't necessarily mean that they are working properly.
In order to overcome this problem, many doctors order even more tests, to get to the "root" of the problem. Thus, they order "sperm function tests" , to try to determine the functional competence of the sperm. However, these tests are expensive , and of very limited use.
A far better option is to explain the limitation of all diagnostic technology to patients. This is one of the reasons why a lot of the focus in our clinic is on bypassing problems rather than diagnosing them. This is why we adopt the success based approach where the question we try to answer is not, "Why I'm I not getting pregnant?" But, "What should I do in order to get pregnant?"
Fortunately , our technology for bypassing problems and solving them in the IVF lab is far better than our technology for being able to diagnose and identify problems !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !