Wednesday, May 09, 2018

Overdiagnosis in IVF - how some IVF clinics increase work for themselves.

Lots of IVF doctors are very trigger happy, and make a diagnosis which is completely inaccurate. For example, they will do an ultrasound scan for a patient on the fifth or sixth day of the cycle and notice at that time that the follicles are small or the endometrium is thin , and then tell her, "Oh, your thin endometrium means that you most probably have endometrial tuberculosis, and you need investigation and treatment for this." 

This is plainly ridiculous ! On Day 6, most fertile women will have small follicles , because they haven't started growing yet , as a result of which their estrogen levels are going to be low, which means their endometrium is bound to be thin. This is normal , and doesn't mean there'a anything wrong. If they repeat the scan in another 4 days, they will see that the follicle grows and the lining will become thicker. 

However, the moment the doctor starts creating this doubt and suspicion in the patient's mind, they generate a lot of unnecessary anxiety, and I think it's important that doctors stop doing this.

The trouble is that they take advantage of the fact that patients are not very well educated or well informed . Most don't understand what the doctor is saying, and quite frankly, infertile patients are so desperate that they will pretty much accept whatever a doctor says, especially when the doctor is an IVF expert. 

This ploy allows doctors to create a lot of busy work for themselves, because once you've made a " diagnosis" , you then need to confirm it . This means you subject the patient to even more tests, which would include things like hysteroscopies  or endometrial biopsies, which not only waste a lot of money, they also waste a lot of time .

This is why the doctor needs to be systematic  and well organized, and not be opportunistic and do a test whenever they feel like. There is a standard protocol which needs to be followed for all patients, and tests should not be done just because the patient happens to come for a consultation on Day 6 of her cycle ! 

The only way to prevent this kind of abuse is to make sure that patients are well informed.

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