How your Gynecologist can be dangerous, if you are infertile

Most infertile couples go to a gynecologist for their medical treatment. While gynecologists are usually a good first choice for treating infertility, they do not have any specialty training in this field where the technology is progressing by leaps and bounds, as a result of which they can actually harm your fertility.

Common mistakes

Here are some of the common mistakes which gynecologists make when treating infertile couples.

  • Most gynecologists are very poor at interpreting semen analysis reports or dealing with infertile men. This is hardly surprising , because they specialize in providing health care for women. This usually means that if you happen to have male factor infertility, they do not have a clear picture as to what your best treatment options are.
Many will just refer your husband to a urologist , as a result of which your care will get fragmented; while others will try to improve a low sperm count with medicines. The biggest tragedy , however , is when they try to treat male infertility with IUI treatment. For men with low sperm counts, IUI treatment is extremely ineffective because their sperm are functionally incompetent and cannot fertilize their wife's eggs.

However , because gynecologists tell them - You only need one sperm to get your wife pregnant !", they end up wasting a lot of time and energy pursuing this futile option.
  • One of the first tests which most gynecologists will do for infertile women is a vaginal ultrasound scan . This will often pick up minor abnormalities such as small ovarian cysts or fibroids. The doctor will then explain to the patient that this is the reason for their infertility , and will advise laparoscopy to surgically to remove this " problem".
In reality , small cysts or fibroids are very common in fertile women ad well, and do not usually affect your fertility . In fact, surgical exuberance in removing them can actually end up reducing your chances of getting pregnant by causing adhesions or reducing your ovarian reserve.
  • One of the commonest diagnosis gynecologists make when doing a laparoscopy for infertile women is that of endometriosis. When they find this , they happily conclude that this is the cause for the infertility and then proceed to treat it , often by suppressing it with Lupron. This is a great example of jumping to the wrong conclusion , because of inadequate information.
There is no evidence to show that mild endometriosis causes infertility or that " treating " it with laparoscopy or suppressing it with Lupron helps infertile patients to conceive . However , most women don't know this, as a result of which they end up wasting a lot of time and money pursuing this ineffective treatment.
  • Most gynecologists often do not realize what a major adverse impact aging can have on a woman's ovarian reserve. They often wrongly reassure the patient that if her periods are regular that this means her eggs must be of good quality too. They rarely bother to test ovarian reserve, as a result of which the older woman often fritters away a lot of valuable time.
  • " If you have a hammer , you only see nails. " This is a common failing for gynecologists as well. There will keep on repeating clomid treatment cycles or IUI treatment cycles, even after the patient has reached the point of diminishing returns.
  • Many gynecologists still bad mouth IVF. Some of them will actually discourage a patient from pursuing this option , because they are reluctant to accept defeat or lose their patient to a fertility specialist. They emphasize the financial expenses and risks of IVF; and continue to tell their patients that it has success rates of only 10% per cycle, even though the technology has improved considerably.
  • Most gynecologists do not have a good insight into the infertile couple's emotional turmoil, and are not very good at providing counseling or empathy.
  • Most gynecologists do not design a plan of action for the treatment of infertile couples. They often treat them on ad-hoc cycle by cycle basis; and give them excessive hope about their chances of getting pregnant on their own, without any scientific rationale for doing so.
  • I think the biggest problem is that gynecologists waste the patient's time. Some of them do so with good intentions , because they want to help the patient to get pregnant without pursuing expensive treatment options such as IVF.
The road to hell is paved with good intentions , and in their misguided attempt to save their patient some money , they often and up wasting a much more valuable and irreplaceable resource - time !

So does this mean that every couple should go running to a RE if they need help in getting pregnant. Definitely not ! Your gynecologist should still be your first source for advice, but even If you are happy with your gynecologist, I would still suggest you get a second opinion from an RE to make sure that you are on the right track.

Read more-Who should you go to - Gynecologist ? Or Infertility Specialist

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.