I’m a huge believer in patients “owning” their medical treatment. You, the patient, are in charge. Your doctor is an educated partner, but not the ultimate decider. That must be you. This goes for all medical treatment, including (especially?) infertility treatment.
Given my position on being in charge of my medical care, it is no surprise that I love the idea of the Choosing Wisely campaign. Choosing Wisely is an initiative of the ABIM Foundation to help physicians and patients engage in conversations to reduce overuse of tests and procedures. Medical specialty societies, including The American Society of Reproductive Medicine (ASRM), along with Consumer Reports, have identified five tests or procedures commonly used in their field that patients should question. The goal is to spark discussion about the need – or lack thereof – for many frequently ordered tests or treatments.
Five Infertility Tests or Procedures the ASRM Says You Should Question
- Diagnostic laparoscopy for the evaluation of unexplained infertility
- Advanced sperm function testing in the initial evaluation of the infertile couple
- Post-coital testing for the evaluation of infertility
- Thrombophilia testing on patients undergoing routine infertility evaluation
- Immunological testing as part of routine infertility evaluation
The ASRM’s reasoning and evidence to support their suggestions can be found here. Keep in mind that the ASRM is not saying these tests and procedures should never be used, just that they should not be routine.
Agree? Disagree? How comfortable do you feel discussing the benefit of specific procedures or tests with your doctor?
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It is hard to question your fertility doctor…sometimes you feel like you are at their mercy and don’t want to piss them off. I guess if you feel like you cannot speak to the doctor you should find another one.
AnonT. Such a good point. I think the ASRM guidelines would make it easier since you could say that you saw them and wondered how they would apply to you. Still, it’s not easy, I know.
Dawn,
I would also add testicular biopsies and extractions for men who have not had full blood work to rule out hormonal or genetic causes for azoospermia. I’ve read stories of men who had those procedures done w/out any blood work done and it ended up being a wasted procedure when nothing was extracted. I’ve also read stories of women put on clomid w/out their husbands being tested that ended up where the husband was the one who is infertile.
I think it’s important for any couple to both be tested fully prior to any treatments. The toughest situations are those with unexplained infertility where the couple is so desperate to find out what is wrong and they are vulnerable willing to try anything.
I agree with you that we all have to be responsible for our medical care but it’s hard when you are vulnerable and might not be of sound mind.
Greg, I’m glad you mentioned the absolute necessity of doing a sperm analysis at the beginning.
May I please say I disagree very much with their statement on “Thrombophilia testing on patients undergoing routine infertility evaluation” I know I say how many miscarriages I had and I say about my son dying and I get told because of my daughter being born that I can’t possibly understand what its like to have a diagnosis of never having a baby but I do that is what they told me. I was tested. Then I got pregnant and they gave me blood thinners I shot my belly with them every few hours my stomach was black. Then I had plecenta previa got a tear in it and she almost died just cause I was bleeding so badly but bed rest saved her the previa was a separate thing really. Thrombophilia is a serious thing. Turned out my father gave it to me we had my parents tested as well. Then it helped my dad live a year longer with his heart condition, they adjusted his medicine. My daughter has the gene but she won’t have to suffer through any losses to have a healthy baby. They will call her high risk give her blood thinners and she will deliver on the first try.. This is evolution. This is how it works . Evolving and learning how to adapt and survive and continue. If a woman has more than a couple miscarriages go get this test. Save yourself the heartache of a dozen more lost pregnancies. Save yourself the heartache of picking out a headstone and a casket for your tiny baby. Get that test and get it early. If I had started trying to get pregnant a year or two later my window of opportunity would have shut. I was 33 when Ruby was born already at the tail end of child bearing years when it was figured out. It’s highly unlikely I’ll conceive another child at 42. These days I’m of the opinion the old family stories about an aunt conceiving at 47 are just wives tales. I’m fairly well convinced they were adoptions after learning how much trouble women have getting pregnant in their 30s
I think each person needs to be able to communicate with their doctor, know the tests, know the reasons for the tests, kniw their own body, and be able to manage their own care. In general, I am pro more testing rather than less. This is because my dad died from not getting what would have been an easy test. So I say better safe than sorry. On the other side, using a frivolous example, once I had a sick cat at the vets. They wanted to do a bunch of tests to determine if it was stomach or intestinal issues. I finally asked what treatment would be and the vet said steroids regardless of diagnosis. Well just give us the steroids then. During our infertility journey I took 4months of clomid before insisting they test my husband. He came back with 0 sperm. Had they done the test sooner I would have been saved 4 months of misery. Yet after, they still wanted to conduct more tests on me which I thought was ridiculous. Fertility issues have such an emotional component. Some couples need those extra tests before being able to ‘let go’ or move to adoption. I would not deny or condemn them for that.