Thursday, May 28, 2020

Why immune testing for patients with repeated IVF failures and repeated miscarriages is a waste of time and money

Patients who have failed repeated IVF cycles even though apparently perfect embryos were transferred, are understandably upset, frustrated and distressed. They are looking for answers as to why they are not getting pregnant, and a plausible reason is that their body is "rejecting" their embryos.

 This is why immune testing for patients with reproductive failure has become very fashionable recently. There is a long list of expensive tests which many labs now perform - and these include: DQ Alpha, Leukocyte Antibody Detection, Reproductive Immunophenotype, ANA (Antinuclear Antibody), Anti-DNA/Histone Antibodies, APA (Antiphospholipid Antibodies), Natural Killer ( NK) Cell Assay and TJ6 Protein. 

This mind -boggling range of catchy acronyms conceals the fact that no one knows whether the immune system is really responsible for the failure of the embryos to implant in these women. Many labs use different protocols to carry out these tests, which are still poorly standardized. This means that results for the same test from different labs vary widely, making interpretation very difficult. 

Also, intelligently interpreting these tests in individual patients is virtually impossible, because of the considerable overlap in the results in normal fertile women and those who are infertile, since many fertile women will also have abnormal results when subjected to these tests. Sadly, most labs do not bother to standardize their test results by doing them on normal fertile women. This means that if a woman who has had an IVF failure is subjected to these tests and has an abnormal result, her doctor happily jumps to the erroneous conclusion that he has now "diagnosed " the reason for the IVF failure, little realizing that the abnormal result could just be a "red herring", since "abnormal " results are often found in "normal " fertile women as well. (These are called " false positives " - test results which are abnormal ('positive'), even though the patient has no disease.)

 A false positive result causes needless anxiety, and will often lead to a situation in which the patient will have to undergo even more tests to prove or disprove the previous results. Remember that if your doctor performs enough tests on you, it is a mathematical certainty that he will find something wrong with you. And if he finds something wrong with you, he'll usually end up treating you - whether you need treatment or not !

Tuesday, May 19, 2020

The two major problems with TESA - testicular sperm aspiration

TESA is a simple technique by which doctors can extract sperm from the testes. It’s partly because it's so simple, that it's often been abused, misused and overused.
Thus, many doctors will do TESA unnecessarily , and extract sperm directly from the testes, even in men who have sperm in the semen sample. Not only is this cruel, it also adds needlessly to their expense – without improving the pregnancy rate ! They use all kinds of pretext to justify this TESE ( for example, by claiming that the sperm will be “fresher” or will have lesser DNA fragmentation, but this is rubbish !). The reality is they do this only so they can charge more money, but this is completely uncalled for ! TESA should only be used for patients with azoospermia. 

Secondly, a lot of doctors don't do the TESA properly , because they don't know how to do the procedure properly. Many urologists will still do an open biopsy, which is painful and unkind. Gynecologists don’t have the necessary expertise, and will often make only half-hearted attempts to suck out sperm from the testes. They end up doing only a fine needle aspiration, and then because they haven’t sampled the tissue properly, it’s misreported as "no sperms are found". This can be misleading, because you actually need to take multiple samples properly and suck out testicular tissue in order to examine the entire testes. If this is not done properly, patients can be misled and made to use donor sperm, and this can be unfortunate. 

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Saturday, April 18, 2020

Why cheap IVF clinics are more likely to cheat you !

There seems to be a spurt of IVF clinics all over the country, and, you will often find one at every corner. Many doctors believe that IVF is a very profitable line of business and they want to join the bandwagon to make money. 
Unfortunately, patients aren’t able to differentiate between good clinics and bad clinics. 
They think of IVF as being a commodity service , and naively believe that all clinics are equally good. 
Patients look for convenience, which means they want clinics which are close to where they live as well, and they prefer cheaper ones as well.
What they forget that these are often the clinics which are much more likely to cheat them , because they are more focused on increasing volume and profits , rather than providing high quality medical care. 
Until patients learn to ask the right questions, the number of patients who are going to get cheated will keep on increasing progressively !

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Friday, March 06, 2020

Head versus heart in IVF

Many educated patients find it very hard to deal with IVF failure, especially when the cycle was perfect, and the doctor transferred a top quality blastocyst into the uterine cavity when the endometrium was receptive.
After all, the doctor did everything possible, and the blastocyst looked perfect, the endometrium was 8 mm and trilaminar, the transfer went smoothly and the doctor was really optimistic !
So then why did the cycle fail ?
The reality is they understand that medical science doesn't have the answers to all their questions, but they find it very hard to accept this.
Because they are educated , they expect that medical science will have all the answers.
However ,  we need to accept the limitations of medical technology . After  all, when we put an embryo back in the uterus, we can't monitor or track or control what is happening to it. This is a microscopic ball of living cells, and implantation is a biological process which is notoriously inefficient !
The problem is these patients are emotionally very vulnerable , and don't want to accept the truth that not everything is in our control !
They want answers, which is why sometimes doctors end up manufacturing them , just to keep them happy, by running additional expensive genetic tests and offering experimental expensive unproven treatment. Sadly, this doesn't help them reach their goal at all, and just ends up making them waste money !

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Do’s and don'ts after the embryo transfer.

Lots of patients are very worried that they will do something stupid after the transfer, which will reduce the chances of their embryo implanting, and cause their IVF cycle to fail.
These anxieties usually falls into the category of foods which they eat; (hot foods or cold foods); or physical activity. For example, they are scared that lifting weights , or the bumpy ride on Indian roads may dislodge the embryo.
This is why many doctors are happy to give them a long list of do’s and don'ts. Mother-in-laws and mothers and aunts will also chime in, with many old wives' tales. And friends who are pregnant will be happy to add their 2 cents !
The truth is that the natural place for an embryo is the uterus – it’s its natural sanctuary ! An embryo in a uterus is like a pearl in an oyster – it’s safe and secure and nothing you can do can dislodge it, so you really don't need to worry.
Remember that an IVF pregnancy is exactly like a natural pregnancy – the only difference is that you happen to know there is an embryo in your uterus ( which fertile women who are having baby making sex don’t !)
Whether the embryo spends five days in the test tube in the IVF lab, five days in your fallopian tube inside the body doesn't matter – once it reaches the uterus, it’s safe.
Of course, whether it will implant or not is not something we can control – that’s still a biological process we cannot influence as yet !

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