Friday, March 24, 2017

Iatrogenic infertility - when infertility doctors cause infertility !


Being infertile is bad enough, but it's a hundred times worse when the infertility is actually caused by your doctor. This is what we call Iatrogenic Infertility and it is of two types. One is permanent , where your fertility is damaged irreversibly because of something which the doctor does. The second is temporary, where your fertility takes a beating because of the medical intervention he advises.

Permanent damage is usually because of surgical procedures. The three commonest offenders in this regard are
hysteroscopic metroplasty;
laparoscopic ovarian drilling;and
laparoscopic surgery for treatment of endometriosis.

Let's look at these one by one.

A hysteroscopic metroplasty is an operation which is done only by Indian gynecologists . For some weird reason, they feel that infertile Indian women have a small uterine cavity , and they make cuts in order to increase the size of their uterine cavity. This is completely ridiculous, because every woman, no matter how fertile she is, is obviously going to have a small uterine cavity when she is not pregnant. Nature has designed the uterus so that the cavity will automatically grow once she gets pregnant, so this is a completely pointless procedure. However, it's become extremely popular, simply because most gynecologists have itchy fingers - they are happy to put in telescopes wherever they can, including the uterus. It's easy to convince the patient to do this hysteroscopy procedure, because they call them " minimally invasive" , thus giving the impression that there's very little risk involved. Once they put the telescope inside, they always want to do additional procedures so they can charge more, and the commonest "add-on" is a metroplasty. This is done for the flimsiest of pretext, "Oh, the cavity doesn't look fine. It's a little bit narrow. I can't see both the cornu, so let me make a few cuts to fix the problem - all kinds of funny reasons. The harm is that these unnecessary cuts can cause scarring , and damage the endometrium. The irony is that these scars cause the cavity to shrink, so that patients become infertile because of a procedure which they didn't need to do in the first place !

The second common offender is laparoscopic ovarian drilling, where doctors drill holes in the ovaries for women with polycystic ovarian disease. Now, if this is done sensibly  ( restricted only to women who have large ovaries, with increased stroma; and performed conservatively ( only 3-4 drills per ovary), it can be helpful. However, many over-enthusiastic doctors end up burning and destroying too much ovarian tissue in these women. They end up causing ovarian failure in these poor unfortunate women , who started off having lots of ovarian reserve , but are now doomed to being infertile because their ovarian reserve has been damaged. That's especially true when some doctors repeat the surgical drilling , because they don't think the earlier doctor did a good job !

Finally, laparoscopy for endometriosis often causes a lot of harm. It's especially tragic because these patients don't require a laparoscopy in the first place ! The trouble is that in their enthusiasm to destroy the endometriosis, they often remove normal ovarian tissue, causing the woman to become infertile , and pushing her from the frying pan into the fire.

Temporary infertility is usually because of medical interventions.  The commonest problem is when women are put on anti-TB treatment because of a positive TB-PCR tests. They end up taking these toxic drugs for nine months. Often patients get so fed up , that they drop out of infertility treatment, thus depriving themselves of their chances of having a baby. This is also true for patients who are subjected to multiple IUI cycles . Every new doctor wants to repeat the old IUI treatment once again , either because they don't have anything better to offer , or because they feel that the IUI done by the earlier doctor wasn't good enough. By wasting a lot of the patient's precious time, they reduce her ovarian reserve because she ages, and this ends up compromising her fertility. Most of these patients are not willing to do an IVF cycle, because of the repeated IUI failures, as a result of which they have no confidence left in infertility doctors. Even if she does finally screw up her courage and do an IVF cycle, her ovarian reserve has dropped because she has become older, and this reduces her chances of getting pregnant even with IVF.

If you want to make sure that your infertility doctor does not add to your infertility problems, you do need to do your homework !

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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