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Patients ( and IVF doctors ) need to remember that we treat patients - not abnormal lab reports ! I provide a free second opinion by email, and I get lots of queries from patients who need help in interpreting their lab test results.
Things that matter
Many of them are worried when their blood test result is outside the normal range. What does an abnormal AMH mean , doctor ? How do I treat this? They often get obsessed with this number - and feel that if they can get this number back into the normal range, they'll be able to get pregnant. They worry about:
- Low sperm counts;
- Low sperm motility ;
- A high number of abnormal sperm ( abnormal morphology);
- Abnormal DFI ( sperm DNA fragmentation index);
- High TSH levels;
- High prolactin levels
Since medicine has become so technology dependent, the number of numbers infertile couples can now worry about has increased by leaps and bounds ! And since many doctors love ordering tests, there is now a near 100% probability that they will have at least one abnormal result.
Most tests have limited utility
The trouble is that they do not realise the limitations of all these test results. What's even worse, is that many doctors do not appreciate the limited utility of these tests either. For one thing, there's a lot of variation - and results can vary from lab to lab - and even from month to month , when tested in the same lab. Many of these tests are not standardized - and their utility has have never been validated in clinical practice.
However, much more important is the fact that these tests rarely provide a black or white answer and there is usually a lot of overlap in the test results between fertile couples and infertile couples. Thus, many fertile men ( who have had babies in their bedroom) will have abnormal sperm morphology; or a high DFI.
However, because they have enough sense not to go to a doctor, they will never even know that their results are "abnormal". Even worse, neither will the infertility specialist realize this, because he sees only infertile patients.
The moment he sees an abnormal result, he is quite happy to jump to the conclusion that this is the "cause" of the infertility - and will happily go about trying to "treat " this. Patients are also happy that this clever doctor has finally "diagnosed" the elusive problem and will now fix it - little realising that this is just a red herring and they are barking up the wrong tree.
Common sense is important
Patients - and their doctors - cannot afford to become automatons and reflexively respond to "abnormal" test results by trying to treat them ! They need to use their common sense !
A good doctor does not treat numbers - we treat patients ! We need to look at the number in its clinical context - and interpret it accordingly.
Not every abnormality is of clinical significance - and most can be left alone, as just being normal variants, of no importance. The trouble is that you need quite a bit of experience and maturity to understand when "masterly inactivity" is the best option. There is a lot of pressure on both doctors and patients today to "test and treat" - never mind the fact that neither the "testing" or the "so-called treatment" has never been proven to be useful.
Even worse, some patients will get pregnant after the "treatment" - simply by the law of averages ! The doctor's belief that the treatment he provides is useful and effective gets reinforced even further - and he starts to swear by it, little realizing that his entire approach is flawed.
If your infertility doctor has "testitis" and orders lots of tests for you ( as many seem to do these days), it's a mathematical certainty that one of these test results will be abnormal. Once we detect an "abnormal test result", we are then forced to treat it .
What works and what doesn't
The sad truth is that often we do not know whether this " treatment " actually helps you to have a baby or not. This is one of reproductive medicine's dirty little secrets - we know very little about what really works, and what does not.
The good news is that in the big picture this really does not matter, because patients don't care about problems - they only care about solutions. And while we are not very good it identifying problems, thanks to IVF, we are very good at bypassing them !
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