| Patients with unexplained
infertility often find it very difficult to accept this
diagnosis, and their commonest plaint is - I wish I knew
why I wasn’t getting pregnant. They are also not
sure how to proceed – “After all, if the doctor
cannot find out what the problem is , how will he be able
to fix it ? “ Unfortunately, they are so focused
on trying to find out what the problem is they often
get paralysed into inactivity . Since they do not get
any clear answers , they keep on doctor shopping. This
increases the confusion, because they get widely varying
opinions and treatment options, so that they don’t
know what to do next. ( By contrast, for a woman with
damaged , blocked tubes, the absence of alternatives
makes decisions making easier ! They only have 3 choices
– remain child-free; adopt; or do IVF).
Unfortunately people get so obsessed with diagnosing
problems so that they can fix them, that they end up
doing a zillion investigations, and identifying millions
of minor irrelevant problems, which have no bearing
on the fertility problem. However, they concentrate
their energies on correcting these so called problems
( whether it’s pus cells in the semen; minimal
endometriosis; high levels of NK cells , an abnormal
SCSA result, or whatever) that they lose sight of the
important goal, which is a baby ! It’s important
to focus your energies on your goal, so you don’t
waste time and energy or irrelevancies.
It is interesting to see how fashions in medical science
also change with regard to these patients . For example
, many years ago , the diagnosis of luteal phase defect
was very commonly invoked, and this was a very popular
diagnosis to explain the infertility in some of these
couples and many investigation protocols and treatment
protocols were also designed to treat this “problem
“. After all, doctors , just like patients, are
happier when they have a name to put on a particular
disease .
The problem with treating unexplained infertility is
that anything can work , which is why there are so many
anecdotal successes with all forms of treatment. Since
infertile couples are emotionally very vulnerable ,
they are often willing to try any treatment fad , in
the hope that it’ll work for them.
Also since everything is “normal” , many
of these couples are hell-bent on achieving a natural
pregnancy in their own bedroom. After all if everything
is normal , then there really is no reason why they
can't get pregnant in their own bedroom, is there ?
And all of us have heard success stories of people who
have conceived after ten to fifteen years of trying
. Unfortunately , these couples often end up wasting
a lot of precious time . The fact remains that if people
haven’t got pregnant in their own bedroom within
three years of trying , the chances of their conceiving
on their own are very low. It is no longer cost effective
or time effective for them to keep on waiting , because
they pay a price for this waiting – and the price
they pay is a loss of their reproductive potential.
This often means that by the time they seek infertility
treatment , there is little an infertility specialist
can offer them .
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I always remind my patients with unexplained infertility
that the quality of the answer depends on the quality
of the question , and the question should NOT be –
“Why am I not getting pregnant ?” After
all , no one cares about problems - people only care
about solutions ! The right question is – “
What can I do in order to get pregnant ?” Rather
than waste time and money on irrelevant tests , it's
important to formulate a treatment plan of action to
maximize the chances of success . Never do a test or
investigation if it does not change your treatment plan
!
The good news is that even though our medical technology
for diagnosing problems in the area of infertility is
not very good , our technology for solving them today
is brilliant .
This is the reason why IVF is such an effective treatment
option for patients with unexplained infertility –
it allows us to bypass all the possible barriers to
the eggs and sperm meeting within the human body –
even if we cannot name these barriers , or come to an
“accurate diagnosis “ in the individual
patient. I remind my patients that IVF allows us to
do in the lab what should normally have happened in
their bedroom , and is not happening because Nature
has let them down . We still may not be able to pinpoint
where Nature has let them down , but once they have
a baby in their hands , this then becomes a question
of merely academic interest .
This success-oriented approach to infertility means
we need to turn the conventional medical principle of
making a diagnosis and then deciding the correct treatment
upside down, but it’s easier to understand this
approach by looking at a simple analogy. Suppose you
want to go from Boston to New York, and your car breaks
down half-way. One option is to take the car to the
garage , let the mechanic diagnose the problem, and
then let him fix it. The other option, which is much
better if you are in a hurry, is to just take another
car and drive it down to New York. The important this
is to reach New York – how you get there is really
not important ! Similarly, as long as IVF allows us
to bypass the medical problem ( even if we don’t
know what the problem is and we can’t put a name
to it), and allows patients to get the baby they want,
then it makes much more sense to go in for IVF, rather
than waste time on testing , and fixing minor and often
irrelevant problems.
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