Saturday, March 01, 2014

Unexplained Infertility or Improperly Evaluated Infertility ?

Infertility is the inability to conceive and in some couples, the exact cause is undetectable. This is known as unexplained infertility. In these couples  all the investigation reports come back as normal. However, only 10% of infertile couples can be labeled as having unexplained infertility. It is also one of the most misused diagnoses by doctors and IVF specialists.

Many doctors do not have time for their patients as they run assembly line clinics.  The doctor prescribes a regular panel of tests and once these tests come back as normal , the doctor is in a hurry to label the patient as having unexplained infertility. Unfortunately not all of these patients have been correctly evaluated .

The diagnosis of unexplained infertility simply means that even with today’s medical technology , we are unable to always point out the reason behind the inability to conceive. Our tests and investigations do not have the accuracy to be able to find all the causes. However, this should be a diagnosis of exclusion. In some cases it so happens that the doctor does not bother to do the right tests which can help in reaching the correct diagnosis.  This may because he may not be uptodate or well-informed; or that sophisticated modern testing facilities are not available in his town.

For example the blood test for AMH levels gives an indication of the ovarian reserve of the patient. Patients with low ovarian reserve have difficulty conceiving naturally and are best managed by IVF.  This diagnosis is quite commonly missed by gynecologists and patients end up wasting a lot of time and money trying to have a baby in their bedroom, because the doctor has mis-labeled them as having unexplained infertility.  Part of the problem is that not all the causes have symptoms or signs, and a doctor needs to hunt for the right diagnosis by ordering the right tests. Similarly, the diagnosis of male infertility is often missed, because the semen analysis is not done properly.

On the other side of the spectrum are infertility specialists who over-order tests ( such as PCR testing for TB or tests for NK cells) in order to come to a diagnosis. They also create a lot of harm, because they unearth a lot of incidental findings, which do not affect the patient’s fertility at all, but are then considered to be the “cause” of the infertility.  Any abnormality on these  test reports is considered to be the cause of the infertility. In reality, many of these abnormal test results are of no clinical importance at all , and they are often found in fertile couples as well. However , the patient is fooled into a false sense of security. She feels that because the doctor has now made the right diagnosis, they will be able to get pregnant, because the correct treatment will now be started. However, too much testing can be as harmful as too little testing !

Our philosophy is completely different. We believe that the question should NOT be “Why am I not getting pregnant ? “ - rather, it should be – What can I do in order to get pregnant ?” After all, no one cares about problems – we only care about results – about having a baby ! This is why we use a success-oriented approach which bypasses problems !

Need help in making sense of your test results? Please send me your medical details by filling in the form at so that I can guide you better !

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