Tuesday, January 18, 2022

Unexplained infertility is easy to treat !


One of the commonest diagnoses we make for infertile couples is called unexplained infertility. 

Patients get very upset with this diagnosis , because they believe that if the doctor cannot find out what the problem is , then either he is not a good doctor because he seems to be groping in the dark, or even worse , he will not be able to find a solution. After all, don’t you need a diagnosis so you can prescribe the right treatment ?

This is why, when a patient gets a diagnosis of unexplained infertility , their first step is to get a second opinion from a new doctor , and the new doctor orders an entire battery of tests . He repeats the old ones ( because he doesn’t trust the earlier labs), and adds many more, most of which are extremely expensive , because he wants to show off to the patient that he is very thorough and experienced, and knows a lot more than the earlier doctor.

The truth is that all these expensive tests don’t provide any useful information . In fact, they actually end up creating more confusion , because the doctor is going on a hunting expedition, and is looking for problems to find. However, most of these new tests haven't been clinically validated , and "abnormal " results mean nothing, because many fertile couples will also have abnormal results ( but because they have enough sense not to go to a doctor, doctors are blissfully unaware of this fact).

If your diagnosis is unexplained infertility , you should actually be happy – this means that your eggs, sperm, uterus, and tubes seem to be normal ! This is far better than having a zero sperm count (azoospermia), or blocked fallopian tubes !

The truth is that all tests have certain limitations , and our technology cannot answer all the questions that doctors and patients ask.

For example, while our tests ( HSG and laparoscopy) can tell us if your fallopian tubes are open , we can't tell you whether they are working properly or not . We can check anatomical patency, but not physiological function. 

Just because we can't answer that question doesn't mean that there is any point in running more tests ! No matter what the results of these additional tests may be , this doesn't change any of the treatment options we can offer you , which is why there’s no point in doing them at all.

The quality of an answer depends on the quality of the question , and the question really shouldn't be - Why am I not getting pregnant ? A far better question is - What should I do in order to get pregnant ?

Unexplained infertility simply means that your eggs and sperm are not meeting in the fallopian tube when you have sex in the bedroom , and we cannot determine the reason because of the limitations of our testing technology.

The good news is that we can increase the probability of the eggs and sperm meeting, either by doing IUI, or by doing IVF ( if IUI fails).

A basic rule in medicine is that before agreeing to do any test , you need to ask your doctor: how will the results of the test change my treatment options ? And if the test results aren’t going to lead to any actionable information, then don't let the doctor do the test just to satisfy his curiosity !

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

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