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 !

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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