Thursday, April 14, 2016

How can "unexplained infertility" be a diagnosis ?


A patient was very upset when I told her that her diagnosis was " unexplained infertility" . She said - " How can you possibly call that a diagnosis , when unexplained means that you don't have an explanation for why I am not getting pregnant ? How does putting a label on it help ? "

I can understand her confusion , and I explained to her why it's important for doctors to assign patients into diagnostic buckets. It makes easier for us to categorize them, so that we can then design treatment plans based on our experience with lots of other patients with a similar diagnostic label.

Unexplained infertility is often a wastepaper diagnosis . What we are really telling the patient is - We don't have a clue why you're not getting pregnant. This can be very upsetting for some patients , who naively believe that medical technology should be able to solve all their problems . They believe that a doctor who can't even tell you why you're not having a baby is incompetent , and pressurise him to order more tests, so that he can get to the " root " of the problem and fix it.

This is why they will often demand the doctors do lots of additional tests , and most doctors are happy to humour them, even though they know that the tests are useless .  A good doctor will tell them the truth and say - There's no point in running any more tests , because these additional tests are not cost effective or reliable , and they do not provide us with any useful information.  Patients don't want to hear this, because  medical ignorance and uncertainty make them uncomfortable. Their fear is that if the doctor cannot even identify the problem, then how on earth will he be able to solve it ? They will often switch doctors, until they get someone who keeps on running battery after battery of expensive tests, until he finally unearths an "abnormality". This is quite likely to be an irrelevant red herring, but the patient is finally happy, because this clever , new doctor has finally made the right diagnosis !

The good news is that unexplained infertility doesn't mean it's untreatable infertility.
All it means is that while our technology cannot pinpoint what the defect is. This is hardly surprising,  given the fact that human reproduction is such a complex process ! However, we can often bypass problems , without identifying them. This is the beauty of ART ( assisted reproductive technology) , because it allow us to do in the lab what's not happening in the bedroom , no matter what the reason for this may be. Sometimes this is a reason which we can identify - such as a low sperm count ; and sometimes it is a reason we can't, which is when we label it as unexplained infertility.  Our solution is equally effectively in both groups of patients !

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 !




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