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The difference between unexplained infertility and incompletely evaluated infertility

Posted Jun 14 2012 11:25pm
A number of gynecologists are very quick to label patients as having unexplained infertility. They do the basic tests , such as a semen analysis ; an internal examination ; a HSG and an ultrasound scan – and if all these results are normal , they tell the patient that we do not know why you're not getting pregnant and label her as having unexplained infertility.While it is true that about 10 percent of infertile couples will actually have unexplained infertility is also equally true that this diagnosis is often misused because doctors do not perform a complete evaluation.

Unexplained infertility is simply a confession of our medical ignorance – it just means that our technology is still not good enough to be able to pinpoint all the possible problems which interfere with fertility in all infertile couples. However, there are some tests which have become recently available which can play a very important role in helping to identify what the problem is. However, many gynecologists are not aware of these tests , as a result of which they do not order them. This means that their unfortunate patients continue to live in a state of ignorance , wasting valuable time and depriving themselves of getting the right treatment
One of the areas which is often ignored by general gynecologists is testing for ovarian reserve. This requires a simple blood test called an AMH level ; and an ultrasound scan to test for antral follicle count. These are simple and inexpensive tests , but many gynecologists will fail to order them , because they do not think about them. This ignorance can prove to be expensive for the patient.

The other danger is that there are many infertility specialists today, who order too many tests , in order to identify some kind of a problem in all the infertile couples they see. They believe in being “thorough and meticulous” and routinely order panels of tests for all their patients. It is a simple matter of mathematical probability that the more the tests your order, the higher the chances of finding something abnormal. While ordering tests is very easy , making sense of abnormal results is actually much harder . Doctors do not have much experience with some of these newer tests , which have never been validated properly . Any abnormality the doctor finds is then blamed as being the reason for the infertility - and doctors will then try to treat it. Unfortunately , a lot of these so-called abnormalities are just incidental red herrings , which are often present in fertile couples as well. “ Treating “ them wastes a lot of time and money - and often causes patients to get fed up and frustrated.

This is why it's important that patients learn to be well informed so they can navigate the fine path between the Scylla of overtesting and the Charybdis of undertesting.

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