Some tests prescribed by some IVF specialists are extremely expensive, a lot of them in fact provide information which is of absolutely no use in diagnosing or treating infertile couples.

I just received this e-mail from patient. He was looking for IVF treatment, and had been requested to do the following panel of tests by another IVF clinic, before going for a consultation.

For your wife,
-FSH done on day 1 or 2 of menses
-Thyroid peroxidase antibody
-Anti-thyroglobulin antibody
-Vit D 25 Dihydroxy
-Fasting and 2 hours post lunch blood sugar
-Trans vaginal pelvic USG between day 10-14 of menses.

For yourself,
-Semen analysis

Seeing this long list of tests made me cringe. Not only are some of these tests extremely expensive, a lot of them provide information which is of absolutely no use in diagnosing or treating infertile couples.

Unfortunately, this seems to have become the typical practice pattern for most medical specialists today. Rather than talking with the patient or using their clinical judgment, they prefer ordering a boatload of tests, and then start focusing their energies on treating the abnormalities these reports generate, rather than treating the patient.

All this over testing does not help with increasing success rates. Over testing just leads to overtreatment and a waste of time and money. It is a mathematical certainty that the more the tests you order, the more the abnormalities you are going to pick up. A lot of these abnormalities are incidental red herrings which have no bearing on the fertility potential of the couple, because they are found in normal fertile couples as well. However, once an abnormality is found, the doctor is forced to "treat" it !

Few doctors will take the time or energy to explain to patients that an abnormal result could just be a statistical variant; is often of no clinical significance ; and can be happily ignored.
Unfortunately, patients also contribute to this epidemic of over testing. Many patients are very happy when doctors order lots of tests for them - and the more expensive they are, the better ! They feel that doctors who order lots of tests are much more thorough and complete - after all, someone who orders so many tests must be a real expert, because he's looking for problems which the earlier doctor missed completely, as a result of his ignorance !

Unfortunately, more is not better, and patients need to beware of doctors who mindlessly order panels of expensive tests for all their patients.

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

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