In Infertility/IVF treatment tests have major role and many doctor go for series of tests. For doctor it’s much easier to order a test than to talk to the patient, which means that many doctors will mindlessly order a battery of tests in order to make a diagnosis. Few patients ( or even doctors for that matter) , question the cost effectiveness or utility of these tests, which are mechanically performed on a “routine” basis, especially in many US clinics.

“Overtesting” just wastes money, sometimes it does have more serious consequences. Ordering tests is easy, but interpreting them intelligently is hard ! Consider the common example of the presence of “pus cells “ found in a semen analysis. Often these cells seen on microscopic examination are actually sperm precursor cells which are found in normal semen. However, they are very commonly misreported as “pus cells” and many doctors then promptly label the man as having a genital tract infection, and treat him with an endless variety of antibiotics, in order to try to “clear up “ the infection.

The unreliability of medical tests also poses a major problem today. The most obvious reason can be attributed to laboratories whose functioning is marked by factors such as poor quality control, unskilled manpower and obsolete equipment.

Unfortunately, when infertile patients change their doctor, many doctors insist on repeating all the tests all over again, because they do not trust the results of any lab other than their own. This is very unfortunate, and patients often end up wasting even more time and money.

Ironically, it is true that sometimes doctors do tests because the patients demand them. This is very common, for example, with couples who have unexplained infertility, who often demand that the doctor continue performing tests till he can accurately diagnose what the reason for their infertility is.

What is our approach towards testing our patients ? We try to simplify testing, by explaining that there are only 4 things we need to test:

eggs
sperms
uterus
and tubes.

The semen analysis to check the husband's sperm count and motility, after requesting him to abstain from ejaculation for at least 3 days .

The wife's blood is then tested for measuring the levels of her four key reproductive hormones: prolactin, LH ( luteining hormone) , FSH ( follicle stimulating hormone) , TSH ( thyroid stimulating hormone). Since these levels vary during the menstrual cycle, they should be done between Day 3-5 of the cycle.

We then do a hysterosalpingogram (an X-ray of the uterus and tubes) for her after the menstrual bleeding has stopped - between Day 5-7, to confirm her uterus and tubes are normal.

We then see the couple on Day 9 with all these reports and review the results . These three basic tests allow us to check whether the eggs, sperm, uterus and tubes are normal.

Here are some of the tests which many doctors will subject their infertile patients to, which we feel are wasteful and unnecessary.

An endometrial biopsy ( EB ) or D&C ( dilatation and curettage) for endometrial sampling ,
 

TORCH tests.
Doppler test
Sperm function tests.
Laparoscopy.
PCR for endometrial TB.
Immune testing for patients with repeated IVF failures and repeated miscarriages .

Interestingly, just like over-testing can lead to problems, we have also noted that under- testing can be equally problematic ! Thus, we have seen many men who have been advised to undergo IVF treatment, based on the report of just a single semen analysis report, which was abnormal. It is essential that the semen analysis be repeated, after a period of 4- 6 weeks, to confirm that the abnormality is persistent, because sperm counts do vary considerably, even in normal men.

You should also make sure that your doctor examines your original scans and X-rays, and not just the reports, because his interpretation may be different from the radiologist's. If you have undergone a series of scans, they should be arranged in chronological order, so that the doctor can compare them easily.

Here's a checklist of questions you should ask your doctor when a test is recommended:

1. Why is the test being ordered?

2. How definitive is the test? Is it the 'gold standard' for making the diagnosis? Will it reveal for sure that a condition is present or not, or must it be repeated or followed by more sophisticated tests?

3. What precisely will the doctor be looking for in the results of these tests? What does he hope to learn from the tests? How accurate are they?