When an IVF cycle fails , patients are distraught , and demand that the doctor provide them with a reason for the failure . Doctors are happy to oblige by doing lots of additional tests – including
Immune tests (Read more about why immunological testing is useless at https://www.drmalpani.com/knowledge-center/articles/why-immune-testing-is-a-waste-of-time-and-money-for-patients-with-ivf-failure)
ERA ( The ERA test is a waste of time and money. Read more at https://www.drmalpani.com/knowledge-center/articles/why-the-new-expensive-endometrisal-receptivity-tests-are-useless)
PGS ( PGS reduces pregnancy rates. Read more at http://blog.drmalpani.com/2014/03/when-more-is-not-better-in-ivf-pgsccs.html)
Hysteroscopy ( A hysteroscopy is not needed if the uterine lining is trilaminar on the vaginal ultrasound scan. There is no need to do a surgical procedure if we can get the same information from a nonsurgical test !) Read more at https://www.drmalpani.com/amp/knowledge-center/articles/why-hysteroscopy-before-ivf-is-not-a-good-idea
The reality is most of these tests are completely useless , because they do not provide any useful, clinically actionable information . However, because patients demand answers , doctors are happy to satisfy them by ordering additional tests. Not only does this earn them more money, this also signals to the patient that they are being extremely thorough and comprehensive and are exploring all possible avenues in order to determine the possible causes for the failure so they can improve their chances for success the next time around.
Unfortunately , doctors hide the truth from their patients. The newer the test, the more expensive it will be ( and therefore more profitable for the doctor to order), but it will also be much more unreliable because it hasn’t stood the test of time , and we don’t know enough about its limitations because its accuracy and predictive value have still not been established. Ideally, these tests should only be offered as part of a clinical trial, but patients are quite happy to blindly believe what their doctor tells them to do, because it’s much easier for them to toe the line.
It’s only when their second and third cycles continue to fail , in spite of all this unnecessary testing , do they realise that they were taken for a ride .
We are aware of the tests other doctors order, and it’s easy for us to order them as well , but we consciously refuse to do so , because we do not think they provide any useful clinical actionable information , and will not change the patient’s treatment options.
While some educated patients appreciate the fact that we are practicing evidence-based medicine and trying to save them time, unnecessary expenses , and anxiety , other patients will feel that we are not being thorough and complete, and not doing all the tests they read about on the websites of other IVF clinics.
They will then leave us and find another doctor who will do the additional tests they crave, so they will have peace of mind that every possible test under the sun has been done. Sadly, most of these tests generate useless data because they are riddled with false positives. This noise confuses both patients and doctors, who are then happy to lead their patients down many expensive rabbit holes , causing them to waste even more time , money and energy .
The biggest tragedy is patients remain completely clueless , because they never realize how useless these tests were !
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