The Truth About Unnecessary IVF Tests: What Your Doctor May Not Tell You
Patient: Dr Malpani, we’ve had two failed IVF cycles, and our doctor now wants us to undergo a whole bunch of new tests. There’s an ERA test, some immune tests, sperm DNA fragmentation... It’s overwhelming and expensive. Are these really necessary?
Dr. Malpani: I’m glad you brought this up. You're not alone—this is something I hear from many patients. Sadly, over the last few years, there's been an explosion in unnecessary tests and treatments in IVF. Many of these sound very cutting-edge, but they’re not backed by solid scientific evidence. Let’s unpack them one by one.
Patient: Sure. Let’s start with the ERA. Our doctor said it helps identify the best time for embryo transfer by checking the receptivity of the uterus lining.
Dr. Malpani: The ERA, or Endometrial Receptivity Assay, is one of the more popular new-age tests. It sounds very precise, but in reality, its usefulness is highly questionable. It was marketed as a way to personalise embryo transfer timing, but large studies have failed to show any improvement in pregnancy rates for most patients. It's expensive, and it rarely changes the outcome.
Patient: That’s surprising. What about the immune tests? We were told maybe my body is rejecting the embryos.
Dr. Malpani: Ah, the so-called immune rejection theory. Tests like NK cell assays or cytokine panels have become trendy, but again, the science behind them is shaky. There’s no proven link between NK cell levels in the blood and what happens in the uterus. These tests often lead to expensive treatments like IVIG or steroids, which come with risks and no guarantee of success. It’s playing on patient anxiety, not sound medical reasoning.
Patient: We were also told to do sperm DNA fragmentation testing. My husband's regular semen analysis was fine, but now they say this test might explain the embryo quality issues.
Dr. Malpani: Sperm DNA fragmentation is another controversial area. While there are some cases where it may be relevant—such as repeated IVF failures with very poor embryos—it’s not a routine test. And even if the result is abnormal, the treatment options are limited and often unproven. It’s one more test that adds stress and cost without clear benefit.
Patient: But why are these tests so commonly recommended? Are doctors just trying to be thorough?
Dr. Malpani: That’s part of it. But unfortunately, many IVF specialists are gynaecologists by training—they may not have a deep understanding of genetics, immunology, or male infertility. So when they face an IVF failure and don’t know what to do, their reflex is to order more tests. The more esoteric the test, the more it seems like they’re getting to the “root cause”, when in reality, they’re just shooting in the dark.
Patient: Are doctors not questioning these tests themselves?
Dr. Malpani: Many don’t. They attend conferences where these tests are promoted by labs or companies, often through sponsored talks. They come back convinced that they must use these tests on all their patients. And yes, sometimes there are financial incentives or kickbacks from labs that make these tests even more attractive to offer.
Patient: That’s really disappointing to hear. As a patient, I just assumed that if a test was being suggested, it must be necessary.
Dr. Malpani: Of course you would. It’s natural to trust your doctor. But that’s why I keep saying—patients need to be well-informed and ask tough questions. Not every test adds value. In fact, many just increase cost and confusion. What you really need is a clear, evidence-based strategy tailored to your specific case—not a random collection of expensive investigations.
Patient: So how do I know what’s really needed and what isn’t?
Dr. Malpani: Start by educating yourself. Read from reliable sources. Ask your doctor to explain how the results of a test will change your treatment plan. If they can’t give you a clear answer, that’s a red flag. And if you ever feel uncertain, please don’t hesitate to get a second opinion.
Patient: Thank you so much, Dr Malpani. This conversation has really opened my eyes.