Tuesday, February 01, 2011

Dr Malpani tells you what to do if your test results are abnormal during your infertility workup

There's always a lot of anxiety when you have to go a doctor - and this is especially true when you have to do your tests to find out if you are fertile or not.

When your test results come back as abnormal, this is often your like your worst nightmare coming true ! The first response is often one of disbelief - maybe the lab mixed up my sample ?

Then start the mind games ! Oh God - does this mean I will never be able to have a baby ? Will we ever be able to fix this problem ? Will my spouse leave me if I cannot have a baby ?

Rule number one - please do not panic ! Remember that every problem has a solution - even if it may not be a very palatable one initially !

Please look at the silver lining - you are actually better off , because now at least we know what the problem is . The known enemy can be better than the unknown, because we can not focus our energies on bypassing the problem and finding a solution , rather than just groping blindly in the dark !

Also, remember that not every abnormality is clinically important. Many doctors will uncritically ask for a huge battery of tests for every couple to comes to them. Ironically, some patients are impressed by such a long ( and expensive !) testing protocol - wow - this doctor is very thorough ! He's doing so many more tests than the other guy did - which means he must be much better informed and more knowledgeable !

However, many of these so-called abnormal results are just normal variants, which are of no clinical importance. They are often found in normal healthy fertile couples as well ! They are just red herrings, which do not need any treatment at all ! Examples include: small ovarian cysts; small intramural fibroids and a positive TB PCR on endometrial biopsy. However, because doctors are so focussed on looking for problems, every time they come across an abnormality, their knee jerk reflex is to start treatment ! Sadly, many patients are also quite happy when the doctor "finds" an abnormality ! Aah - this guy is good ! He's finally found what the problem is ( which the earlier doctors missed because of their incompetence) - and now that he can treat it, I'll finally get pregnant !

However, often overtesting just leads to overtreatment - and to add insult to injury - the wrong treatment, because the doctor is "treating" a "problem" which has no effect on your fertility at all. Patients often end up wasting a lot of time and money - and then lose confidence in doctors - and in themselves ! They refuse to take the right treatment, because they've wasted so much on energy and money on the wrong treatment.

Also, this overtreatment can be dangerous and can actually reduce your fertility ! For example , unnecessary laparoscopic surgery to "treat" a small chocolate cyst can actually harm you, as normal ovarian tissue is also removed along with the cyst wall, thus reducing your ovarian reserve.

Use your common sense - and it's always a good idea to repeat the test before jumping to the wrong conclusion ! Meanwhile, do your homework and learn more about the test; what its variations are - and what they mean.

If you are having a hard time making sure you are on the right track, please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm , and I'll be happy to guide you !

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