Why too many tests can be bad for infertile couples

I see many infertile couples who have a very had a wide range of tests done. Some of these tests are extremely expensive , and don't provide any useful information as regards their fertility. These include : tests for TORCH; tests for NK cells ; and testing for TB.

It's very easy for doctors to order a battery of tests - and because patients expect doctors to do tests in order to find out what the problem is , they are quite comfortable with doing whatever the doctor suggests.

However, the reality is that the number of tests an infertile couple requires is actually very simple and basic - all you need in order to make a baby are sperms; eggs ; uterus and open fallopian tubes. Most of the other tests are completely irrelevant and provide very little useful information because they do not really change the treatment which the doctor can offer you.

When I ask patients why they did all these tests, most of them look completely blank. The commonest response is - I did them because my doctor told me to. This is actually not a good reply, because I expect patients to be well informed ; to understand what tests are being ordered ; and why they are useful for their treatment.

A simple rule in medicine is that you should not do a test unless it changes your treatment options. Unfortunately, sometimes doctors forget this rule - occasionally, for personal financial gain . Some doctors will do a panel of tests for all patients who walk into their clinic. This is the - let's tick all the boxes checklist option to make sure that all the possible relevant tests have been done , whether the patient actually needs them or not. This is a very mindless bureaucratic approach , where the doctor is not behaving as a responsible professional, but just making sure that all the bases are being covered.

Most patients rarely have the courage to ask the doctor questions , which is why they will meekly perform all the tests which the doctor orders. Sometimes , when the odd patient does have the guts to ask why a test is needed , the standard answer is - Just to be sure. These just to be sure tests are completely wasteful ; and often create a lot of red herrings and false passages which lure your doctor down the wrong path , causing you to waste a lot of time, energy and money. While it's very easy for a doctor to order tests ; and it's equally easy for the patient to do what the doctor says without asking too much questions , you need to be careful when tests are being ordered . Otherwise you may find that an abnormal result will lead to a negative vicious cycle of overtesting and overtreatment , which have nothing to do with solving your basic fertility problem at all.

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

Open Video