In some cases the patient
is unable to conceive , even if all the tests conducted are reported as normal
. This causes a lot of frustration , and they go on spending a lot of money ,
to little avail.
Such cases are labelled unexplained
infertility. In these patients, the results of all their fertility tests (hormonal
blood tests for LH, FSH, PRL, TSH and AMH to determine the egg quality; semen analysis; ultrasound scanning for monitoring ovulation ; and HSG or hysterosalpingogram
to determine the tubal patency) are all normal.
These
cases are very frustrating for the patient, because they are unable to
understand why the doctor is still unable to pin point the exact cause of their
infertility. Normally patients expect a scientific answer and a precise
diagnostic label from their doctor , and if he fails to provide this, they are
likely to complain, because they feel he
must not be competent to find the reason for their infertility.
They are unable to understand why they are not able
to get pregnant if all their tests are completely normal ! If the truth be
told, the technology being used for the identification of reproductive problems
is quite crude. Thus we can check if the fallopian tubes are closed or open , but
testing their functioning is another cup of tea ! Similarly , we can easily
check the motility of the sperms , but cannot say anything definitive regarding
their ability to fertilize the egg. In cases of unexplained fertility the basic
reproductive apparatus (tubes, uterus, sperms and eggs) seems to be working
fine. However most patients have the complaint that if the doctor is not able
to find the problem , then how he will find a solution for it.
An even better term for this type of infertility will be undiagnosed infertility , as it is due to the limitations of the
techniques , rather than the doctor or the patient.
However, when patients are told about their
unexplained fertility, they try and pressurise the doctor to run more tests. Most
patients conclude that if their infertility is unexplained, this means it has
not been diagnosed completely or properly . This is why doctors are browbeaten
to conduct unnecessary tests – some of which are very expensive and complex.
Many of these are not related to fertility at all ! However , the problem which
arises with ordering a bewildering multitude of tests is that sooner or later ,
one of them will turn out to be abnormal , even though it doe snot affect your
fertility. The doctor will then proclaim that he has finally found out the
cause of your inability to conceive. To add insult to injury, he will conclude
that he is better than your earlier doctor, who was co incompetent, that he had
not even bothered to order this test !
The major problem with such an approach is that
many of these abnormalities are incidental, and might not be related to your infertility problem at all. However if there is a problem , then the doctor
needs to provide a “solution” for it. This results in wastage of a lot of money
and time. After several failed attempts , many patients get frustrated , and no
longer wish to explore more sensible options like IVF , which could have allowed
them to bypass all their problems, and would provide them with a cost effective
solution !
POSTED BY DR.MALPANI
Articles:
- Dr.Malpani Infertility clinic
- Dr.Malpani Complaints Blogs (Dr.Malpani ratinale behind the Complaints on the Expensive medications)
- Dr.Malpani Complaints Blog (Dealing with patients compliants on infertility)
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