Sunday, December 17, 2017

Taking the infertile man ( and his IVF doctor) for a ride !

All doctors know that a semen analysis has a number of limitations. While it can tell us how many sperm a man has, and how well they are swimming, they cannot answer they key question the infertile man is asking - Can I get my wife pregnant with my sperm or not ?

Now the right thing to do is to acknowledge the limitations of our sperm tests, and then move on with helping them to have a baby ! The beauty is that while the ability of our technology to test male infertility is poor, our technology for treating it is amazingly good, because we can bypass all the in vivo hurdles by doing IVF with ICSI. . This means  we can do in the lab what's not happening in the bedroom, no matter what the reason for the underlying problem !

Of course, doctors are never happy with accepting their ignorance, and like most people, they believe that more is better, which is why they have come up with a new set of sperm function tests, which are designed to test sperm function. Many of these have been proven to be useless ( such as the zona free sperm penetration assay ) , but scientists are always looking out for ways commercialise their reesearch.

The newest kid on the block is the Episona Advanced Sperm Quality Testing assay at The claim to use epigenetic testing to identify men who are at greater risk of having sperm dysfunction.  It's a cleverly designed website - but what it hides is the fact that it really does not provide any useful clinically actionable information ! Of course, this has never stopped andrologists for prescribing this expensive test, because they want to be seen as being at the "cutting edge" of research - even if this is completely useless as regards the patient's chances of having a baby.

The test report is full of genetic jargon, and describes how many fold the risk of having poorly functioning sperm is increased in a given man , based on proprietary tests the company does . They conveniently overlook the fact that the test results do not change the poor man's treatment options - but do live his wallet a lot lighter !

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