Treating shadows in the infertile couple
Modern medicine involves a lot of testing. While some is useful, overtesting leads to unnecessary overtreatment for many infertile couples
As medical technology has improved, it's now possible for us to take images of lots of stuff in the pelvis which we previously couldn't. Since a lot of this technology is noninvasive it's quite easy to do ; and since it's all new , lots of doctors love ordering these tests , so they can offer their patients clever new technological options to show that they practice " state-of-the-art " medicine and are aware of all the latest recent advances. Ordering some of these new imaging tests sometimes is a game of oneunmanship amongst doctors and we're now seeing lots of patients who are getting three-dimensional pelvic ultrasound scans and MRIs scans done for the evaluation of their infertility. While it's true that the anatomical details these imaging procedures provide is quite remarkable , the fact also remains is that these often end up revealing lots of shadows which have very little clinical importance . However, once they've been diagnosed by the radiologist , the Doctor often feels compelled to treat them because he automatically assumes that this abnormality on the imaging study is the reason for the infertility.Even worse , once the patient reads the written report and sees the abnormality on the film, this particular problem becomes fixated in their mind and then they start focusing their energies on finding a solution to treating that particular shadow , rather than treating their infertility as a whole. While these tests can provide useful information when used intelligently and selectively , they often end up creating more problems than they solve. For example a lot of these tests will pick up things like small simple benign cysts ; small fibroids ; or small areas of adenomyosis - lots of stuff which is often found in normal fertile women and doesn't cause any problems at all.
However, when we find these "abnormalities " in the MRI scan in infertile woman , we automatically tend to assume that it is these abnormalities which are responsible for the infertility. This then sets up a vicious cycle of over testing and overtreatment ; and since the treatment these days usually involves simple stuff like minimally invasive surgery , lots of doctors start doing a lot of these procedures , many of which are completely unnecessary and do not actually help the patient to conceive at all.
They end up wasting the patient’s time , money and energy. Patients get frustrated and lose confidence in themselves and in the doctor, and often "drop out” of medical treatment, thus losing their chances of having a baby with the help of IVF technology.
