Unnecessary and useless infertility tests and treatments

ESSENTIAL AND UNUSEless INFERTILITY TESTS AND TREATMENTS

1. Prolactin (PRL), follicle stimulating hormone (FSH), Anti-Müllerian hormone (AMH), estradiol (E2), complete blood count, blood biochemistry measurements are insignificant in a healthy young woman presenting with infertility with regular menstrual cycles and therefore ovulation functions. . It does not contribute to treatment selection and pregnancy prediction.
2. Among the diagnostic tests of infertility, laparoscopy is only necessary if there is a suspicion of a disease or abnormality on examination and or ultrasound that will reduce the chance of pregnancy and increase the success of pregnancy when surgically corrected. It is meaningless to perform laparoscopy on every childless woman.
3. Uterine and canal medicated film – the truth of comments such as “one tube closed, one tube open” or “narrowing of tubes” or “enlargement of tubes” or “tube was clogged, we opened” in hysterosalpingography (HSG) reports or comments in women who have not had previous intra-abdominal surgery the possibility of reflection practically does not exist.
4. The thrombophilia panel (coagulation tests) is not recommended even after recurrent miscarriages, let alone infertility, and even in the presence of abnormalities, treatment does not affect pregnancy success rates.
5. Standard infertility diagnostic tests should include an ovulation test, sperm count, and uterine and canal film. Apart from this, performing hysteroscopy in all cases does not increase pregnancy success rates. Even if the decision for IVF treatment is made, it is essential to perform standard tests. If some problems that may be found are not corrected beforehand, the chances of IVF success are also low. Even if an in vitro fertilization center is applied directly due to infertility, it is deontologically and ethically correct that couples are not looked at with in vitro fertilization glasses and standardized researches are carried out, and the chance of pregnancy naturally is given by correcting the possible causes.
6. Young or middle-aged women who have not even tried the chance of pregnancy but want a baby, or couples who have only tried their chance to conceive for a few months, or couples who have tried to have a baby for a long time but have not yet been investigated for any infertility cause, by looking at FSH or AMH in the blood sample and saying “the number of eggs has decreased. It should be kept in mind that the suggestion of “in vitro fertilization should be done immediately and urgently” may not be the right decision, the success of in vitro fertilization will be lower especially in women with a reduced number of eggs, and the chance of conceiving naturally and having a baby may be higher if the pregnancy is tried for a sufficient period of time or if the reason preventing pregnancy is found and treated. . There are many women of all ages who have had a baby after repeated unsuccessful IVF attempts when given the chance to conceive naturally for a sufficient period of time or with a simple drug treatment.
7. Women who have regular menstruation, that is, ovulation, only need a single egg each month to become pregnant. However, it is necessary to collect a large number of eggs for success in IVF. AMH, FSH, egg count with ultrasound and the statement “you are running out of eggs, you have to hurry” is not realistic. Even if the eggs are reduced, they are never depleted in a few months, so no couple will reduce or lose their chance of in vitro fertilization by trying, evaluating or treating a 3-5 month pregnancy chance. There is no medical equivalent to panicking couples with misdirection.
8. For a woman with ovulation, hence regular menstrual cycles, attempting treatment with Clomiphene Citrate or Letrozole tablet is useless, it will not increase pregnancy rates.
9. Before IVF treatment, efforts to increase the chance of embryo attachment by drawing the intrauterine membrane (which was once fashionable although its effectiveness has never been scientifically proven) do not increase the success rates, so these procedures are not required.
10. Except for some special cases and in order to increase the pregnancy rates under 35 years of age, preimplantation genetic screening of embryos in all IVF cases does not increase the success rates, so it is unnecessary.
11. Except for male infertility cases, intracytoplasmic injection (ICSI) is not required in every case requiring in vitro fertilization in order to increase pregnancy rates.
12. Acupuncture, alternative medicine trials, herbs, vitamins, food supplements, etc. It does not increase the success rates either naturally or with IVF, so it should not be recommended.
13. Research and treatments related to the immune system do not increase the success rates of infertility treatment. Intralipid infusion, intravenous immunoglobulin, leukocyte immunization therapy etc. Experimental interventions are not helpful and not recommended because of their side effects.
14. Platelet-rich plasma (PRP), glue, microchip, ERA, etc., which is claimed to increase the chance of embryo attachment to the uterus. Applications made with the claim of increasing pregnancy success are approaches that do not have scientific evidence, are in trial and error style, applied with commercial concerns and are not recommended.

Conclusion : Infertility is a medical field that is open to abuse all over the world, both with traditional and classical diagnosis and treatment methods, and mostly with IVF interventions. Commercial concerns sometimes cause non-evidence-based and controversial approaches to be added to standard and scientific treatment methods. However, the main thing should be the principle of “Primum non nocere” in the Hippocratic oath, that is, “first of all, do no harm”.

References:

You can access the following videos and articles on www.drkutaybiberoglu.com, doctorsite / facebook / instagram / youtube Biberoglu links.

1. Who benefits from overdose medicine?August 23, 2016
2. Good Medicine, Good Medicine Practice. August 18, 2016
3. The Irresistible Attraction of “Advanced Technology” Apps for Infertility Professionals. September 1, 2016
4. IVF for everyone who wants a child or cause-oriented treatment? 1.02.2021
5. Immoral Offer in Media and IVF Practices. February 28, 2017
6. What does anti-mullerian hormone (AMH) do? – Critical analysis. August 20, 2017
7. Prenatal genetic screening in IVF success – Fact or myth? November 9, 2017
8. Basic information for infertile couples who cannot have children. January 26, 2018
9. For whom IVF treatment should be applied and for whom it should not be the first choice. June 11, 2018
10. What is Infertility? How to Manage?June 11, 2018
11. Delay/preservation of reproduction and oocyte freezing/storage. September 24, 2018
12. In vitro fertilization (IVF) and Preimplantation genetic screening (PGS). September 24, 2018
13. Good Medicine, Good Medicine Practice. April 21, 2019
14. Everything about IVF (in vitro fertilization). October 21, 2019
15. Who should undergo IVF treatment? Who should not be applied? What are the success rates? 11.11.2019
16. How necessary is hysteroscopy in the diagnosis and treatment of infertility? November 11, 2019
17. Should hysteroscopy be performed on infertile women who fail to conceive?15.11.2019
18. Innovations from A to Z in IVF treatment. November 2, 2019
19. Drug therapy in male infertility. December 13, 2019
20. If IVF attempts fail, is the situation hopeless or is there still a chance of having a baby? January 30, 2020
21. Factors that increase the chance of conceiving with IVF treatment and naturally. January 27, 2020
22. What innovations are there in IVF treatment? 11.11.2021
23. Tests requested by physicians for the diagnosis of diseases – How should they be interpreted from the perspectives of physicians and patients – 08.04.2022

prof. Dr. Kutay Biberoglu

03.01.2023

Ankara